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.