Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
89 - Hypnotics
from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- 73 Alcohol withdrawal: management
- 74 Anticholinesterase inhibitors: monitoring of cardiac side-effects
- 75 Anticholinesterase inhibitors: prescribing
- 76 Antimuscarinic medications
- 77 Antipsychotics: combined and high dose
- 78 Antipsychotics: prescribing
- 79 Antipsychotics: use in dementia
- 80 Attention-deficit hyperactivity disorder: prescribing
- 81 Atypical antipsychotics: monitoring
- 82 Behavioural problems in adults with intellectual disabilities: medication management
- 83 Benzodiazepines in old age psychiatry
- 84 Covert administration of medication
- 85 Depot antipsychotics: side-effects
- 86 Diazepam as rescue medication in epilepsy
- 87 Electroconvulsive therapy: facilities
- 88 Electroconvulsive therapy: indications
- 89 Hypnotics
- 90 Lithium: monitoring
- 91 Medicines reconciliation
- 92 Mood stabilisers: monitoring
- 93 Nurses’ administration of medication
- 94 Prescribing: British National Formulary limits
- 95 Prescribing: Mental Capacity Act
- 96 Prescribing: p.r.n. medication
- 97 Prescription charts
- 98 Psychological therapies
- 99 Psychotherapy re-referrals
- 100 Psychotropic prescriptions in dual diagnosis
- 101 Rapid tranquillisation
- Appendices
Summary
Setting
This audit is relevant to any in-patient setting where a significant proportion of patients may be prescribed hypnotics for the treatment of insomnia.
Background
The National Institute for Health and Clinical Excellence (NICE) (2004) has made several recommendations regarding the use of hypnotics for the treatment of insomnia. Insomnia is a symptom often experienced by those suffering from mental illness, and so hypnotics are frequently prescribed within psychiatric in-patient settings.
Standards
Standards were obtained from the audit criteria recommended by the National Institute for Health and Clinical Excellence (2004). These are as follows:
ᐅ Non-pharmacological measures are to be considered before the prescription of drug therapy for insomnia.
ᐅ When used, hypnotic drug therapy should be used for the shortest time necessary, and in strict accordance with the licensed indications.
ᐅ When hypnotic therapy is prescribed, the drug with the lowest purchase cost should be chosen. (The information on purchasing costs was obtained from the chief pharmacist.)
ᐅ Patients should not be switched from one drug to another.
The target was that these standards should be met for all in-patients prescribed hypnotics for insomnia.
Method
Data collection
Data were collected by examining the medical notes and prescription charts of all in-patients within the trust for evidence of the four standards. This was done as a snapshot audit over a pre-specified 2-week period.
Data analysis
The percentage of patients being prescribed hypnotics for insomnia for whom each of the following standards was met was calculated:
ᐅ documentation of the consideration of non-pharmacological measures
ᐅ hypnotic prescription not lasting for longer than 4 weeks
ᐅ drug with the lowest purchase cost used
ᐅ no switch from one drug to another.
The prescribing practices of different units was depicted through the use of pie charts and bar graphs.
Resources required
People
This audit would need to be completed by three or four people, depending on the size of the trust.
Time
For a trust with 250 in-patients, with approximately half of these being prescribed night sedation, it is estimated that data collection would take 20 hours.
Results
ᐅ Documentation of discussions relating to non-pharmacological measures, such as sleep hygiene, was almost universally absent.
ᐅ Compliance with length of prescription of hypnotics was good.
ᐅ Only one patient was switched from one hypnotic to another.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 209 - 210Publisher: Royal College of PsychiatristsPrint publication year: 2011