Use of major and minor tranquilizers with older patients in an acute care hospital: an exploratory study.

Aim: This paper reports a study to determine how many older patients are prescribed major and/or minor tranquilizers during their hospital stay, and the perceptions of acute care nursing staff towards the use of such medications with older hospitalized patients.

Background: While considerable research exists on the use of major and minor tranquilizers (chemical restraints) with older people in long-term care, scant research has addressed the use of these drugs with older patients in acute care hospitals. Given the growing numbers of older people with dementia and delirium in hospitals, and the risks these drugs pose to older people, more research on the use of chemical restraints by nurses with older hospital patients is needed.

Methods: Computerized pharmacy records were used to access data on prescriptions of major and minor tranquilizers to older patients during one month on six hospital units (total n = 498), and 140 nursing staff from these units completed the Perceptions of (Chemical) Restraint Use Questionnaire. The data were collected in 2003.

Results: A minority of older patients (8.63%) were prescribed a major or minor tranquilizer during the one-month data collection period. The numbers prescribed minor tranquilizers (6.22%, n = 31) were approximately double that of major tranquilizers (3.21%, n = 16). The majority of prescriptions for minor and major tranquilizers were written as pro re nata or 'as needed' (77% and 55.8%, respectively). Nurses' scores on the Perceptions of (Chemical) Restraint Use Questionnaire indicated perceptions consistent with liberal use of chemical restraints, and several of the highly rated reasons for giving such medications could be considered inappropriate.

Conclusions: While these findings suggest that only a small number of older people were prescribed chemical restraint medications in hospital, the risks these medications pose warrants ongoing prudence. More nursing research and education on the use of these medications with older people in hospital settings is needed.