Insomnia is a disturbance of normal sleep patterns. It is characterised by sleep onset latency and/or sleep maintenance. Short terminsomnia is defined as having symptoms for less than 4 weeks, whilst long term insomnia is symptoms lasting more than 4 weeks.Hypnotics including the benzodiazepine and non-benzodiazepine (Z-drugs) can provide relief from the symptoms of insomnia; they donot treat any underlying cause.NICE guidance states “After consideration of the use of non-pharmacological measures, hypnotic drug therapy is considered appropriatefor the management of severe insomnia interfering with normal daily life, it is recommended that hypnotics should be prescribed for shortperiods of time only, in strict accordance with their licensed indications”. They also advise to use the lowest effective dose for the shortestperiod possible. Side effects are common with hypnotic usage. This includes most importantly developing tolerance and reboundinsomnia.The aim of our project is to reduce hypnotic prescribing for patients on an Acute inpatient psychiatric ward. The ward is a Male wardcontaining 17 inpatient beds in the Northwest of England. The patients are 18 years onward with varying diagnosis. The reason for doingthis project was most importantly for improving patient safety via reduction of unnecessary prescriptions and administration ofmedications, but also for cost and carbon footprint reduction of the NHS.Patients included in this project were inpatients on the selected ward between the 09/12/2020-20/01/2020 and 28/01/2020-10/03/2020.The interventions used to fulfil our aims included development of an educational presentation about Insomnia and sleep management,development of an Insomnia management flow chart to be used at admission point and at weekly reviews (Appendix 1), training sessionfor ward staff, patient sleep hygiene and management educational sessions, face to face and email correspondence to inform medicaltrainees about this project and gathering feedback from patients and staff before and after this project.The data we collected included the specific Hypnotic medication, dose and quantity prescribed on the ward during these dates. With ourinterventions we have demonstrated a 44.5% reduction in hypnotic administration. This highlights the positive change the interventionshave resulted in. This will improve patient safety by reducing the risk of side effects, and by reducing the number of patientsbeing discharged on a regular prescription which will further reduce long term costs of hypnotic medications for the NHS.The small changes that we have applied have resulted in a massive improvement in our clinical care and patient safety, with the addedbenefit of a reduction in the pharmaceutical environmental impact that over prescribing can result in.
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