Sleep is a big part of people's physical and psychological health. It is even more important when it comes to the more at risk population, such as patients. Multiple diseases, patient variability and a vast amount of contradicting research make the treatment of insomnia complicated and complex. We conducted a retrospective study, researching the impact television – as a sleeping aid – has on the patients with a TV in their rooms. We were also measuring the impact of the TV implementation in terms of lowering the sedative prescribing. Within this study we also looked at the prescribing structure and the prescribed dose of sedatives in correlation with the prescriber and pre/post TV period. We analysed the patient documentation of the Center for clinical toxicology and pharmacology (CKTF), University Clinical Center Ljubljana. The period before the implementation of TVs spanned between August 1st 2016 and January 31st 2017. The period after the implementation of TVs spanned between August 1st 2017 and January 31st 2018. Television was introduced into patients' rooms in April 2017. The study included 612 patients, 302 in the period before the addition of TVs and 312 from the period after. In the period before there were 181 (61%) women and in the period after the implementation of TVs 142 (46%). Both periods – before and after – include more than 80% of patients age 65 years or older. In the period before – 85%, in the period after – 86%.
The data was kept and analysed in an Excel file. In total, the patients in the group before the TVs were added, stayed in the hospital 3163 days, and after the TVs were added the patients total stay was 2783 days. Days with the prescribed sedative totaled 829 before the TVs and 696 days after the TVs. The study includes sedatives mainly prescribed at the CKTF for battling insomnia, benzodiazepines (alprazolam, bromazepam, diazepam, klonazepam, lorazepam, medazepam, midazolam), quetiapine and zolpidem.
The percentage of days with a sedative take into account the days which have a sedative prescribed in the evening and not necessarily during the day. Before the implementation of TVs, the patients were prescribed a sedative 23,8% of the days at the hospital, and in the period after 23,4%, the difference is not statistically significant. The average number of units of diazepam 5mg equivalent per day of sedation changed from 0,80 units before the TV to 0,90 units after the TV was introduced and the change is statistically significant (p<0,0001). Prescriber A kept the percentage of days with a sedative at a similar level (before 20,8% after 19,6%, p=0,78), however he lowered the average prescribed dose of sedatives (before 1,09, after 0,90 units of the 5mg diazepam equivalent per day of sedation), which is a statistically significant change ( p<0,0001). Prescriber B lowered the percentage of days with a sedative statistically significantly (before 26,5%, after 9,1%, p=0,011) while keeping the dose almost unchanged (before 0,90 after 0,91 units of the 5mg diazepam equivalent per day of sedation, p=0,833). Prescriber C increased the percentage of days with a sedative (before 26,7%, after 38,9%, p=0,00032), which is statistically significant and increased the average unit of the diazepam equivalent per day prescribed from 0,78 to 1,06 units, which is also statistically significant (p<0,0001). Television is not the sole factor influencing the changes in sedative prescription. We noticed that doctors and their attitude to sedatives had a big influence on the outcome.
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