2026 Eastern States Conference

Title: Impact of pharmacist-led interventions on zolpidem de-escalation in hospitalized geriatric patients

Authors: N Lukan, PharmD; M Spoor PharmD, BCPS; C Maness PharmD, BCPS; T Hazirjian, PharmD; J Spano, PharmD

Learning Objective: At the end of this presentation the audience should be able to describe strategies to optimize zolpidem usage in geriatric patients

Self-assessment question: Which of the following pharmacist-led interventions can help reduce inappropriate zolpidem prescribing in hospitalized geriatric patients? (select all that apply)
a. Performing automatic dose reduction of zolpidem from 10 mg to 5 mg
b. Discouraging the new initiation inpatient zolpidem
c. Educating prescribers, nursing staff, and pharmacists about the risks of zolpidem
d. Encouraging zolpidem to be administered on a scheduled basis as opposed to as needed

Background/Objective: The objective of this study is to evaluate the impact of pharmacist-led interventions on the number of zolpidem orders and mean dose of zolpidem in hospitalized geriatric patients.
 
Methods: This retrospective study assessed zolpidem prescribing patterns before and after targeted pharmacist-led interventions. The pre-intervention group included patients hospitalized from December 2024 to February 2025 and the post-intervention group included patients from January 2026 to March 2026. Patients with an inpatient order for zolpidem were eligible for inclusion if they were 65 years of age or above. Patients were excluded if an order for comfort measures was placed at any time during their hospitalization. The primary outcome measures were the number of orders for zolpidem per 1000 patient days and the mean dose of zolpidem ordered. Secondary outcome measures included 30-day all-cause readmission rates, number and type of pharmacist interventions, number of documented falls, and retention of intervention at discharge. Categorical variables were analyzed using Chi-square tests and continuous variables were assessed using paired student’s t-tests.

Results: A total of 172 zolpidem orders were reviewed with 131 meeting inclusion criteria. After four orders were excluded, the pre-intervention group contained 71 orders, and the post-intervention group contained 56 orders. Baseline characteristics were similar between groups. The primary outcomes were not statistically different between pre- and post-intervention groups. Among secondary outcomes, documented pharmacist interventions increased significantly post-intervention (p = 0.036), with dose change interventions representing the predominant increase in intervention type (p = 0.001). Post-hoc analysis demonstrated a statistically significant decrease in mean zolpidem dose administered in the post-intervention group (p = 0.017).  

Conclusion: Implementation of an automatic dose reduction protocol and targeted pharmacist-led interventions led to no change in number of zolpidem orders, no change in mean dose of zolpidem ordered, significant reduction in mean administered dose of zolpidem and increase in documented pharmacist interventions. Further study is warranted to evaluate strategies that sustain pharmacist interventions at discharge.