Deprescribing benzodiazepines across different healthcare settings: a quality improvement initiative

Due to growing awareness of risks associated with benzodiazepine (BZD) use, these medications are now considered potentially inappropriate for older adults. Despite this, older adults are more likely to receive these medications than younger adults, with those in long-term care (LTC) being particularly vulnerable, emphasising the importance of reducing BZD prescriptions. Other studies have shown success in reducing BZD prescriptions using a patient-focused multicomponent intervention: however, this approach has not been well studied in LTC.During a seventeen-month quality improvement (QI) initiative conducted in an Edmonton LTC facility, a patient-focused multicomponent intervention (pharmacist-led medication review, counselling, patient and staff education, and new patient information resources) was implemented to reduce BZD prescriptions by 50%. Outcome measures included changes in BZD prescriptions and patients' usage of BZDs, including dose and dosing frequency. Process measures included intervention component delivery, while balancing measures included financial cost, number of falls and additional medication usage.Numerous unforeseen complications arose, related to the facility and participant recruitment, which required several study adaptations. Ultimately, our goal sample size was not reached. All 10 recruited participants underwent the intervention, resulting in several individuals having their BZDs deprescribed. Although all participants received printed patient information material, few were formally educated. However, two staff education sessions were conducted, which were well attended and received. No complications ensued, and financial costs were minimal.While our QI initiative reduced BZD usage, implementation challenges and a smaller than predicted sample size likely impacted the results obtained. Staff education was well received, suggesting further education is needed. The challenges encountered require subsequent cycles to fully assess the intervention's effectiveness and sustainability, including a more comprehensive assessment of the context, enablers and barriers. By sharing our experience, we hope to optimise the success of future research initiatives, as these challenges are common within research.