A Unified Primary Care Approach for the Management of Insomnia and Confusion Using the Clinical Pathway

Abstract

Background: Delirium and confusion are risk factors for falls and its related injuries. Therefore, we
designed a unified clinical pathway to reduce the risk of delirium among hospitalized patients.

Methods: A unified approach of pharmacotherapy for managing insomnia and confusion, which is
subdivided based on the patients’ age (<70 versus ≥70 years) and presence of diabetes mellitus, was
implemented in Nagoya Memorial Hospital, Japan. Risk factors for delirium were assessed via a
multidisciplinary approach. For older high-risk patients, suvorexant or trazodone was prophylactically
prescribed to promote sleep. If delirium occurred, either quetiapine or perospirone was administered prior
to the usage of risperidone or haloperidol. The amounts of prescribed sleep inducers and antipsychotic
agents were examined. The application rate of the clinical pathway and incidence of falls were compared
before and after its introduction.

Results: The application of a unified approach for the management of insomnia and confusion
significantly decreased the prescribed amounts of benzodiazepines and may be associated with the
reduced incidence of falls among hospitalized patients.
Conclusions: A clinical pathway assisted the selection of sleep inducers and antipsychotic agents. This
is useful for managing inpatients safely by preventing delirium and subsequent falls.