Title

Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes.

Introduction
We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study.

Method
In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out.

Results
Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of short-acting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening.

Conclusion
The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.