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In-patients on mental health wards are commonly prescribed hypnotics for the long-term management of disturbed sleep. Specific sleep disorders remain underdiagnosed and effective behavioural interventions are underused. We developed a suite of three educational interventions (a video, poster and handbook) about sleep, sleep disorders, the safe prescribing of hypnotics and use of psychological strategies (sleep hygiene and cognitive–behavioural therapy for insomnia, CBTi) using co-design and multiprofessional stakeholder involvement. This controlled before-and-after study evaluated the effectiveness of these interventions across seven in-patient psychiatric wards, examining their impact on hypnotic prescribing rates and staff confidence scores (data collected by retrospective drug chart analysis and survey respectively).
Results
A marked reduction was seen in the percentage of patients prescribed hypnotics on in-patient prescription charts (−24%), with a 41% reduction in the number of hypnotics administered per patient (mean reduction −1.142 administrations/patient).
Clinical implications
These simple educational strategies about the causes and treatment of insomnia can reduce hypnotic prescribing rates and increase staff confidence in both the medical and psychological management of insomnia.
the use of prostaglandians in maintaining the patency of the arterial duct in congenital heart disease is well established. Intravenous1-3 and ora12–4 administration has been used, although for acute use intravenous and possibly intraosseous5 routes are favored. Both prostaglandin E1 (alprostadil—ProstinVR: Upjohn)1,4 and prostaglandin E2 (dinoprostone—Prostin E2: Upjohn)2,3 are used for this purpose, although only prostaglandin E1 is licensed for this indication in the United Kingdom. Prostaglandin E1 costs approximately 8 times more than prostaglandin E2 (£56.96 versus £7.43 per vial).
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