Prior studies suggest that more than a quarter of adult hospitalized patients receive benzodiazepines or other sedative-hypnotics (BSH) for sleep, the majority of whom are naïve users. While the rate of adults that chronically use BSH are declining, a recent report from Choosing Wisely Canada (CWC) and the Canadian Institute for Health Information (CIHI) demonstrates that overuse remains prevalent, with 1 in 12 older adults using BSH regularly. The most common reasons for BSH use are related to managing insomnia, delirium, and agitation in hospital. However, the risk of cognitive, psychomotor, and daytime fatigue often outweighs potential benefits of BSH. Furthermore, patients who receive new prescriptions for BSH after leaving hospital are at increased risk of becoming dependent on these medications for sleep. Use of BSH is also associated with preventable harm such as falls, fractures, and delirium. Quality improvement initiatives can successfully reduce inappropriate prescribing of BSH in hospitalized patients.

Purpose
This toolkit was created to support the implementation of interventions designed to reduce overuse of BSH in hospital settings.

Target Audience
This toolkit is well suited for hospitals that have confirmed overuse of BSH related to sleep management. This toolkit can be used by inpatient care providers, clinical services, or hospitals to help achieve significant reductions in overuse of BSH.