Implementing Evidence-Based Non-Pharmacological Interventions to Reduce Diazepam Prescription Among Elderly Cataract...

This quality improvement (QI) project aimed to implement evidence-based non-pharmacological interventions to manage preoperative anxiety and reduce diazepam prescriptions among elderly patients undergoing cataract surgery at an ambulatory surgery center in New York.

A pre-post quality improvement design was used to compare outcomes before and after the implementation of a non-pharmacological anxiety management bundle.

Staff training on the 4 M framework and the risks of benzodiazepine use in elderly patients was conducted in August 2024, followed by implementation of a bundle of non-pharmacological interventions (music, stress balls, fidget spinners, art therapy, and aromatherapy) from September to November 2024. Outcomes included diazepam prescription rates (baseline: N=789; implementation: N=853), patient intervention preferences tracked via inventory count, and nurse satisfaction assessed using a modified Nurse Satisfaction with Quality of Care Scale (NSQC) administered before and after implementation.

Diazepam prescriptions decreased significantly from 10.6% at baseline to 5.5% during implementation (χ²(1, N=1642) =17.23, p < 0.001), reflecting a nearly 50% reduction. Among the 207 intervention items used, stress balls (N=111) and aromatherapy (N=78) were most frequently selected. Nurse satisfaction scores showed a positive trend (mean rank 7.94 pre-intervention vs. 10.19 post-intervention), though this difference did not reach statistical significance (p = 0.37).

Non-pharmacological interventions can effectively reduce diazepam reliance in elderly patients undergoing cataract surgery while supporting age-friendly, patient-centered care. Integration of staff education and accessible distraction tools offers a scalable, low-cost approach to improving perioperative safety and nursing confidence in geriatric surgical settings.