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Benzodiazepine utilization in a university hospital
M H Zisselman1, B W Rovner, K G Kelly
1Department of Psychiatry and Human Behavior, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Objective:
To assess benzodiazepine utilization and documentation in hospitalized medical and surgical patients in relation to demographic characteristics.
Methods:
Retrospective review of computerized university hospital database and medical records.
Subjects:
6,020 consecutive medical and surgical admissions from January through June 1992.
Measurements:
Utilization of four commonly prescribed benzodiazepines (Halcion, Ativan, Valium, Xanax) in relation to age, race, sex, length of stay, hospital service; and documentation of indications for use.
Results:
2,491 patients (41.4%) were prescribed a benzodiazepine during their hospital stay. Patients over 65 were as likely to receive a benzodiazepine as younger patients. Benzodiazepine utilization was associated with admission to a surgical compared to a medical service (49.0% vs. 37.3%, P < .001), race (white 45.7% vs. non-white 29.9%, P < .001) and length of stay (11.8 days vs. 6.8 days, P < .001). Review of 30 medical and 30 surgical medical records revealed no documentation of purpose for benzodiazepine use other than as a preanesthetic agent in 23 (38.3%) cases.
Conclusions:
Benzodiazepines are widely prescribed in the hospital setting in the absence of appropriate documentation. Older patients are as likely to receive benzodiazepines as younger patients, despite the known morbidity associated with their use in this population. Differences in prescribing practices by race, the longer length of stay among patients receiving benzodiazepines, and the appropriate use of benzodiazepines in the elderly require further study.