Benzodiazepine receptor agonists in hospitalised patients in the Netherlands: initiation, continuation and discontinuation – a retrospective observational analysis

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OBJECTIVE: To examine inpatient benzodiazepine receptor agonists prescribing patterns and assess how hospitalisation affects use at discharge. DESIGN: Subanalysis of the WEsleep trial, a cluster-randomised controlled single-centre study conducted at Amsterdam University Medical Center (Amsterdam UMC) (two locations) between July 2023 and March 2024. Twelve departments (six medical, six surgical) were matched and randomised to intervention or standard care. On intervention wards, multiple measures to improve sleep were implemented, including minimising nighttime disruptions. SETTING: Amsterdam UMC, across medical and surgical hospital departments. PATIENTS: Adult patients admitted for ≥2 nights (medical) or undergoing elective non-cardiac surgery in a surgical department. PRIMARY AND SECONDARY OUTCOME MEASURES: Benzodiazepine use was classified as no use, pre-admission use or new in-hospital initiation. Prescribing patterns were summarised descriptively according to type, timing, indication and discharge status. RESULTS: Of 746 patients, 187 (25%) used benzodiazepines: 80 (43%) had pre-admission use, and 107 (57%) were newly initiated during their hospital stay. Among pre-admission users, two discontinued and five had adjustments at discharge. Among newly initiated users, 94 (88%) had their benzodiazepine discontinued at discharge. Approximately half of pre-admission prescriptions and one-third of in-hospital prescriptions lacked a documented indication. CONCLUSIONS: Although most newly initiated benzodiazepine treatments were discontinued during hospitalisation, pre-existing use was rarely reassessed and nearly 10% of new users were discharged with a prescription. Structured deprescribing protocols, better documentation of indications and improved discharge planning are needed to promote safer and more rational benzodiazepine use. TRIAL REGISTRATION NUMBER: NCT05683483.

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