Explain concern over the patients long-term use of named hypnotic/s. Include advice on how to gradually reduce or cease use in a manner that is feasible and will decrease the likelihood of withdrawal symptoms.

Explain concern over the patients long-term use of named hypnotic/s. Include advice on how to gradually reduce or cease use in a manner that is feasible and will decrease the likelihood of withdrawal symptoms..

Explain concern over the patients long-term use of named hypnotic/s. Include advice on how to gradually reduce or cease use in a manner that is feasible and will decrease the likelihood of withdrawal symptoms.

* Highlight potential side effects when taken over a prolonged period.
* Ask the patient to consider a reduction in their use. Include advice on how to gradually reduce or cease use in a manner that is feasible and will decrease the likelihood of withdrawal symptoms.
* Invite the patient to discuss the issue further with own GP or by booking into pharmacist led clinic.
4. For those receiving a letter these drugs were moved from repeat to acute and limited to 56 days supply.
5. A 2nd short reminder letter sent to non responders 3 months after the initial letter also informing the patient that the maximum length of supply was now 30 days in line with CD regulations (June 2014).
6. Posters advertising clinics and detailing risks of long term use put up in waiting rooms
7. Agree initiation & prescribing policy for new prescribing support leaflet supplied
8. Full range of support leaflets and reduction schedules available in all consulting rooms.
9. Monthly pharmacist (independent prescriber) led clinics offering 20 minute appointments. Scope of practice demonstrated by Benzodiazepines learning module via MHRA Training and Continuing Professional Development (CPD) and personal CPD records.
10. Reception staff / prescription clerks informed.
11. Raised awareness with local community pharmacies by providing self help leaflets & posters
Main audit observations
o 196 patients prescribed hypnotics 95 patients prescribed benzodiazepine 25 prescribed both.
o Included 37 patients care home residents
o 4 RIP during project
o Age range 5 101 years
o Length of supply range 1 day 100 days
o 99% on repeat
o 107 patients with fall/fell in consultation recording total of 238 falls often leading to GP appointments OOH/MIU/A&E attendances & hospital admissions. This included 14 fractures 54 A&E/admitted and at least 3 road traffic accidents.
o There was occasional documentation of addiction & tolerance discussions.
Clinic Protocol
o Identify & address any underlying cause of insomnia anxiety & depression
o Promote non drug therapies such as sleep hygiene methods and relaxation techniques using diaries & self help leaflets.
o Involve patient support network
o Guided by patient negotiate flexible gradual withdrawal schedule
o Convert to diazepam if appropriate
o Rebook for review ongoing support and encouragement as appropriate
o Continue dose reduction at pace comfortable to patient
o Monitor withdrawal effects until stopped completely or at lowest dose to control effects of withdrawal. Where complete withdrawal may not be an achievable goal there is still benefit to be gained in reducing use to the minimum effective dose. (Ref BNF).
o Revisit benefits of stopping at every contact
o Highlight risks for drivers including details of the proposed 2015 drug driving offence for those affected.
o Link patient into support services (Talking Therapies SMART/T2 age concern Community Veterans Mental Health Service)
What were the potential barriers to success?
* Not perceived to be a problem
* Cheap drugs budget not affected
* Time & impact required
* More commonly used Z drugs are perceived to be safer than temazepam
* Patient resistance
* Limited support programmes available within mental health services
Results
Number of patients seen/telephoned by GPs was not measured. Number of pharmacist led clinic sessions 14 (First clinic January 2014: Last clinic January 2015)
> Number of patients seen 45
> Number of patient appointments attended 97
> Number of DNA 2
X Surgery Q2 (Oct-Dec 13) 2013/14 ADQ 461
X Surgery Q2 (Oct-Dec 14) 2014/15 ADQ 263
After the conclusion of the project X surgery (Q2 2014/15) moved from 4th highest hypnotic ADQ per STAR PU prescribers to 29th out of 50 practices and below England average.
The inclusion of this prescribing performance indicator meant that all 50 practices received a consistent message regarding harms of long term use together with the offer of additional support material. A decrease can be seen by a large number of practices.
No other practice achieved the same magnitude of reduction as X surgery (as seen in Graph 1 below) who had received a higher level of support in terms of education letters sent to patients and pharmacist led clinics over this time period. (Latest epact data available Q2 14/15)
Graph 1 highlighting X Surgery
Medication Results: [12 month time period Oct12 Nov13 vs Oct13 Nov 14 (ePACT)] The number of items dispensed decreased by 572 despite changing prescriptions to 30 days supply and thereby potentially increasing the number of items ordered.
The annual cost of hypnotic and benzodiazepine prescriptions reduced by 8744.35 despite temazepam price fluctuations.
January 2013: Temazepam 10mg 4.23/28
August 2013: Temazepam 10mg 27.08/28
November 2014: Temazepam 10mg 19.77/28
Table 1. Change in X SURGERY prescribing of hypnotics
X Surgery Previous 12 Months Current 12 Months
Chemical Substance Items Cost Items Cost
Temazepam 415 13186.81 205 6554.73
Zopiclone 1023 1894.21 842 1232.56
Lorazepam 230 1096.01 209 787.14
Oxazepam 147 545.84 98 238.27
Nitrazepam 93 500.10 46 138.81
Zolpidem Tartrate 175 457.69 153 279.15
Lormetazepam 6 397.92 4 234.14
Clonazepam 84 239.44 44 108.87
TOTAL 2173 18318.02 1601 9573.67
Melatonin prescribing remained stable indicating patients had not been switched to melatonin as a non hypnotic alternative.
OUTCOMES Benefit to individual practice and wider public health agenda
* Keeping patients from harm by reducing exposure to side effects
* Patient in control involved in own healthcare decisions & empowered to manage their medicines
* Prescriber education promotes consistent patient experience and raised awareness of potential serious side effects for patient and prescriber.
* Improved patient access to healthcare in convenient location with choice of provider
* Vulnerable or complex patients linked into other support agencies
* Opportunity to discuss other medication helping patients to get the most from their medicines.
The final word What particularly went well and what was hard?
Practice engagement over the course of the project was superb. It was well supported from the outset with the delivery of a consistent message and patients actively encouraged to attend the pharmacist led clinic. GPs held steadfast regarding keeping supply on acute rather than repeat at least until the patient had received the relevant support information. Initially pressure on GPs time was high. Inevitably this quickly decreased but was time consuming on top of the usual high work load.
References


 

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The post Explain concern over the patients long-term use of named hypnotic/s. Include advice on how to gradually reduce or cease use in a manner that is feasible and will decrease the likelihood of withdrawal symptoms. appeared first on cheap nursing papers.

Explain concern over the patients long-term use of named hypnotic/s. Include advice on how to gradually reduce or cease use in a manner that is feasible and will decrease the likelihood of withdrawal symptoms.