Bold Voices - June 2018 - 8

AT THE BEDSIDE

America's 'Other'
Drug Problem
Needs Attention
While the opioid epidemic has led to efforts to reduce overprescribing of opioids, another problem may be overlooked
- inappropriate prescribing of benzodiazepines.
"Our Other Prescription Drug Problem," an editorial in The
New England Journal of Medicine, notes that from 1996 to 2013,
the number of U.S. adults filling benzodiazepine prescriptions
increased 67 percent, from 8.1 million to 13.5 million. And
overdose deaths involving benzodiazepines (including alprazolam, clonazepam, diazepam and lorazepam) rose from 1,135
in 1999 to 8,791 in 2015, according to the National Institute on
Drug Abuse.
Even in low-risk
"The adverse effects of benzodiazepine overuse, misuse, and
patients, it is best
addiction continue to go largely
to avoid daily
unnoticed." Many prescribers don't
benzodiazepine
realize that benzodiazepines can
be addictive and that long-term
dosing to mitigate
use can worsen anxiety, contribute
possible issues
to persistent insomnia and lead to
with tolerance,
cognitive decline, accidental injuries or death.
dependence and
"Three quarters of deaths
withdrawal.
involving benzodiazepines also
involve an opioid, which may explain why, in the context of a
widely recognized opioid problem, the harms associated with
benzodiazepines have been overlooked.
"Just as with opioids, some patients benefit from long-term
use of benzodiazepines," the editorial continues. "But even in
low-risk patients, it is best to avoid daily dosing to mitigate the
development of tolerance, dependence, and withdrawal."
A related article in Medscape Medical News notes that older
adults are especially vulnerable to adverse effects, including
falls, fractures and dementia. The article points to evidence
that benzodiazepine use among seniors, particularly those
ages 85 and older, is high and warrants further attention from
clinicians and policymakers.
The editorial suggests that education on safely prescribing
opioids, "already being implemented at all levels of medical
education," should include benzodiazepines. "It would be
a tragedy if measures to target overprescribing and overuse
of opioids diverted people from one class of life-threatening
drugs to another." d
REFERENCE: Lembke A, Papac J, Humphreys K. Our other prescription drug problem. N Engl J
Med. 2018;378(8):693-695.

8 JUNE 2018 | AACN BOLD VOICES

Effect of Haloperidol
on Reducing Mortality

A

study of critically ill adult patients at high risk of
delirium finds that treatment with haloperidol
does not improve survival at 28 days compared to a
placebo.

"Effect of Haloperidol on Survival Among Critically Ill Adults
With a High Risk of Delirium: The REDUCE Randomized
Clinical Trial," in JAMA: The Journal of the American Medical
Association, involved 1,789 critically ill adults treated at 21
ICUs in The Netherlands from July 2013 to December 2016.
The randomized, double-blind, placebo-controlled study
defined a high risk of delirium as an anticipated ICU stay of at
least two days.
Patients were randomized to
receive intravenous prophylactic
treatment three times daily with
1 mg haloperidol (350 patients), 2
mg haloperidol (732 patients) or a
placebo with 0.9 percent sodium
chloride (707 patients).

The findings
do not support
prophylactic
haloperidol to
reduce mortality in
critically ill adults.

Treatment of patients in the 1-mg haloperidol group was
stopped prematurely due to futility. For the other groups, the
study finds no difference in the median days that patients
survived: 28 days for the 2-mg haloperidol group or the
placebo group.
"These findings do not
support the use
of prophylactic
haloperidol
for reducing
mortality in
critically ill
adults," the study
explains.
In addition, a related article in Physician's Briefing points out
"there was no statistically significant difference in any of the
15 secondary outcomes, including delirium incidence, delirium-free and coma-free days, and duration of mechanical
ventilation, ICU, and hospital length of stay. There was no
difference between the groups in the number of reported
adverse events." d
REFERENCE: van den Boogaard M, Slooter AJC, Brüggemann RJM, et al. Effect of haloperidol on survival among critically ill adults with a high risk of delirium: the REDUCE
randomized clinical trial. JAMA. 2018;319(7):680-690.


https://www.jamanetwork.com/journals/jama/article-abstract/2673149?redirect=true https://www.jamanetwork.com/journals/jama/article-abstract/2673149?redirect=true https://www.jamanetwork.com/journals/jama/article-abstract/2673149?redirect=true http://www.nejm.org/doi/full/10.1056/NEJMp1715050 https://www.medscape.com/viewarticle/892983?nlid=120907_4503&src=wnl_dne_180223_mscpedit&uac=234465EV&impID=1566392&faf=1 http://www.physiciansbriefing.com/Article.asp?AID=731297

Table of Contents for the Digital Edition of Bold Voices - June 2018

Urine
The Power of Possibility
Sepsis: What Nurses Can Do
New Sepsis Bundle From Surviving Sepsis Campaign
Understanding CERPs for Specialty Certification Renewal
In Our Journals
Transitions
America’s ‘Other’ Drug Problem Needs Attention
Effect of Haloperidol on Reducing Mortality
Transitional Care Nurses Can Reduce Admissions of Older Patients
ASHP Developing Standardized Medication Concentrations
Online AACN Course on Care of Older Adults
Hospital Programs Help Employees Cope With Traumatic Events
National Summit on Identification, Prevention and Management of Burnout
Barbershops Help Black Patrons Control Hypertension
Nurse Treats Himself for Myocardial Infarction Using Telehealth
We Have Consensus: TeleICU Continues to Evolve
Cooking Classes Help Patients With CHF
Beware of Chicken Nuggets — and Other Ultra-Processed Foods
Apple Watch Might Randomly Reboot in ICUs
Wound-Monitoring App Helps Reduce Hospital Readmissions
All Antidepressants Beat Placebo for Acute Major Depressive Disorder
Patients’ Online Search Trends
‘Timeout’ Reduces Medication Errors
Possible Link Between High Fitness and Reduced Risk of Dementia
DAISY Award Honors Nurses Who Exemplify Exceptional Compassion and Skill
Interviews With Two Acute Care Nurse Practitioners
Hiring for Cultural Fit
AACN Unveils Updated Online Pharmacology Course
Appreciating the Little Things
Bold Voices - June 2018 - Cover1
Bold Voices - June 2018 - Cover2
Bold Voices - June 2018 - Urine
Bold Voices - June 2018 - The Power of Possibility
Bold Voices - June 2018 - New Sepsis Bundle From Surviving Sepsis Campaign
Bold Voices - June 2018 - Understanding CERPs for Specialty Certification Renewal
Bold Voices - June 2018 - Transitions
Bold Voices - June 2018 - Effect of Haloperidol on Reducing Mortality
Bold Voices - June 2018 - Online AACN Course on Care of Older Adults
Bold Voices - June 2018 - National Summit on Identification, Prevention and Management of Burnout
Bold Voices - June 2018 - Nurse Treats Himself for Myocardial Infarction Using Telehealth
Bold Voices - June 2018 - We Have Consensus: TeleICU Continues to Evolve
Bold Voices - June 2018 - 13
Bold Voices - June 2018 - Beware of Chicken Nuggets — and Other Ultra-Processed Foods
Bold Voices - June 2018 - Wound-Monitoring App Helps Reduce Hospital Readmissions
Bold Voices - June 2018 - Patients’ Online Search Trends
Bold Voices - June 2018 - Possible Link Between High Fitness and Reduced Risk of Dementia
Bold Voices - June 2018 - DAISY Award Honors Nurses Who Exemplify Exceptional Compassion and Skill
Bold Voices - June 2018 - 19
Bold Voices - June 2018 - Hiring for Cultural Fit
Bold Voices - June 2018 - AACN Unveils Updated Online Pharmacology Course
Bold Voices - June 2018 - Appreciating the Little Things
Bold Voices - June 2018 - Cover3
Bold Voices - June 2018 - Cover4
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