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Original papers: Lucy Caswell, Imthiaz Hoosen, Christopher A. Vassilas, and Sayeed Haque Reducing hypnotic use on two older adult functional wards: an effective audit? Psychiatr Bull 2006; 30: 95-97 [Abstract] [Full text] [PDF]

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Audits on the use of hypnotics

Faouzi Dib Alam, Tatiana Izotova   (31 August 2006)

Audits on the use of hypnotics 31 August 2006
Faouzi Dib Alam, Doctor , Tatiana Izotova Send letter to journal: Re: Audits on the use of hypnotics docftalam{at}aol.com Faouzi Dib Alam, et al.	Caswell et al (Psychiatric Bulletin, March 2006, 30, 95-97) reported a reduction of hypnotic use on two older adult functional wards following a brief educational intervention. We would like to mention that it is always difficult to ascertain how many prescriptions for hypnotics are written, because benzodiazepines which are commonly prescribed for insomnia are also prescribed for other conditions, and up to 40% of people with insomnia self medicate with hypnotics that are available without prescription from pharmacies (Gurwitz et al, 2000). We also would like to draw your attention to a mismatch in the pre and post-intervention compared groups in the described audit, namely the number of months in the pre-audited intervention sample compared to the post intervention one (6 months compared to 4 months). At a glance this might seem to be trivial, but after a closer look we can see that the so called occupied bed days were very unequal in the 2 compared groups, which meant that the number of tablets prescribed was considerably less in the post-intervention sample. The flaw in the methodology also showed in the difference of patients discharged from the hospital in the pre- intervention group (87 patients) compared to the post-intervention one (27 patients). We recently undertook a similar audit of hypnotic use in psychiatric as well as medical and surgical wards. The audit was conducted against recently issued NICE guidance on the use of Zaleplon, Zolpidem and Zopiclone for short term management of insomnia (NICE 2004). Our results showed that the use of hypnotics on medical and surgical wards was 27%, compared to 29% on the adult psychiatric wards. Unfortunately despite our educational intervention and setting up an action plan, the repeated audit after one year yielded no drop in the use of hypnotics. It may well be that our intervention method was poor but it could also be that one-off intervention session is not effective over time, and that regular intervention sessions should be conducted. We believe that the audit described in the paper was repeated too soon which meant the positive effect of the educational intervention could have been magnified. Declaration of interest: None NICE Guidelines on the use of zaleplon, zolpidem and zopiclone for short term insomnia (April 2004) Last accessed 26/Aug /2006 GURWITZ, J.H., FIELD, T.S. AVORN,J,. et al. Incidence of adverse drug events in nursing homes. American Journal of Medicine, 2000, 109, 166-168 Faouzi Alam Specialist Registrar in Adult Psychiatry, Avondale Unit, Royal Preston Hospital, Shaore Green lane, Preston, PR2 9HT docftalam@aol.com Tatiana Izotova F2, Aintree Hospital, longmoor lane, liverpool L9 7AL.