Sleepless Nights: Trazodone Use and Insomnia Evaluation in the Palliative Care Clinic (QI728)

Abstract

1.Discuss the evaluation of insomnia in the palliative care clinic of a large academic medical center.2.Discuss the use of trazodone in the palliative care population and discuss the concerns regarding the use of trazodone. Insomnia is a common symptom in the Palliative Care patient population with some estimates showing up to 70% of patients having symptoms of Insomnia. However, patients continue to depend on pharmaceutical agents owing in part due to lack of access to Cognitive Behavioral Therapy and longtime use of medications to treat insomnia. Although trazodone has limited efficacy for insomnia, it is used roughly by 1% of the U.S. adult population. We sought to better define within our clinic population the likelihood patients were using trazodone and also the likelihood of recognition of its use for insomnia. evaluate the use and documentation of Insomnia and trazodone use in the outpatient clinic in the palliative care clinic of a large academic medical center. This is a retrospective chart review assessing patients seen in the Palliative Care Clinic at a large academic center from June 2017 to November 2017. Data includes demographics, presence of trazodone in their medication list, and documentation of ESAS (date documented, and drowsiness score). Charts were manually reviewed for any documented discussion of insomnia either in the problem list, discussion, or history. Descriptive statistics were used during analysis. Fifteen (9.2%) of 163 patients had trazodone in their medication list during the review period; 6(40%) were female with mean age of 63.5. Discussion of insomnia was documented for only 4(26.6%) patients. The mean ESAS drowsiness score was 5.03. The most common prescribed dose of trazodone was 50 mg (47%). We were unable to identify thorough assessment or alternative non-pharmacologic strategies within any of these charts. Discussion with patients regarding the effectiveness of interventions to help treat insomnia are rare in palliative care patients receiving trazodone. Future interventions will focus on implementing better screening methods, patient education, and documentation regarding insomnia and its management.