PLANNING FOR QUALITY IMPROVEMENT
Topic Chosen: The area I have chosen for improving within my practice is prescribing of hypnotics in the management of insomnia.
I feel that patients, especially elderly people, who are on sleeping tablets/ hypnotics/ schedule-8 drugs for a long period of time, put pressure on general practitioners for initiation or continuation of these drugs of dependency for treating insomnia and therefore I want to reduce this rate besides improving management of this condition as a whole as it is a very common presentation
Insomnia is defined as “A disturbance of normal sleep patterns commonly characterised by difficulty in initiating sleep (sleep onset latency) and / or difficulty in maintaining sleep (sleep maintenance)".(1) …show more content…
Sleep log:
Patients are given a log book in which they enter the details of timings of going to sleep, time of wakening, time and duration of daytime naps and sleep, factors that can make their sleep worse or better e.g. alcohol or meals, and drug intake regimen.
This sleep log helps to establish whether they have early, middle or late insomnia.
I am giving print of this log to my patients. (7)
I am utilizing this audit questionnaire for assessment and then management of insomnia and dependence on medication. (8)
Practice guidelines for Insomnia:
1st line management of insomnia
• Good sleep hygiene
• CBT (Cognitive Behavioural Therapy) to be conducted by clinical psychologists including stimulus control therapy, sleep restriction therapy relaxation training, paradoxical intention and …show more content…
increasing dose temporarily, using behavioural and cognitive therapies, and avoiding substitutive therapy such as alcohol).
T-aper dosage gradually on an individual basis
• Modify dose and/or frequency based on severity of withdrawal symptoms.
• Allow time to stabilise between dosage reductions (at least several days).
• Consider referral to a specialist if dose reduction proves too difficult in primary care.
• Tailored approaches to benzodiazepine dosage reduction may include:
• Reducing dose by 10% to 20% per week if it is within or slightly above the recommended amount.
• Stabilising on an equivalent dose of diazepam for a few days before dose reduction, if patients were using higher than recommended doses or finding it difficult to reduce the dose of a short-acting benzodiazepine (avoid diazepam in older people).
• If multiple benzodiazepines are used, the dose of each drug may be reduced one after the other.
O-ngoing review and use of non-drug therapies
• Monitor the effect of stopping or reducing use on sleep patterns, mood, withdrawal symptoms and use of other substances (e.g. alcohol, nicotine): aim initially for weekly review.
• Encourage ongoing use of non-drug therapies to manage insomnia and to help with maintaining cessation or reduction in
Topic Chosen: The area I have chosen for improving within my practice is prescribing of hypnotics in the management of insomnia.
I feel that patients, especially elderly people, who are on sleeping tablets/ hypnotics/ schedule-8 drugs for a long period of time, put pressure on general practitioners for initiation or continuation of these drugs of dependency for treating insomnia and therefore I want to reduce this rate besides improving management of this condition as a whole as it is a very common presentation
Insomnia is defined as “A disturbance of normal sleep patterns commonly characterised by difficulty in initiating sleep (sleep onset latency) and / or difficulty in maintaining sleep (sleep maintenance)".(1) …show more content…
Sleep log:
Patients are given a log book in which they enter the details of timings of going to sleep, time of wakening, time and duration of daytime naps and sleep, factors that can make their sleep worse or better e.g. alcohol or meals, and drug intake regimen.
This sleep log helps to establish whether they have early, middle or late insomnia.
I am giving print of this log to my patients. (7)
I am utilizing this audit questionnaire for assessment and then management of insomnia and dependence on medication. (8)
Practice guidelines for Insomnia:
1st line management of insomnia
• Good sleep hygiene
• CBT (Cognitive Behavioural Therapy) to be conducted by clinical psychologists including stimulus control therapy, sleep restriction therapy relaxation training, paradoxical intention and …show more content…
increasing dose temporarily, using behavioural and cognitive therapies, and avoiding substitutive therapy such as alcohol).
T-aper dosage gradually on an individual basis
• Modify dose and/or frequency based on severity of withdrawal symptoms.
• Allow time to stabilise between dosage reductions (at least several days).
• Consider referral to a specialist if dose reduction proves too difficult in primary care.
• Tailored approaches to benzodiazepine dosage reduction may include:
• Reducing dose by 10% to 20% per week if it is within or slightly above the recommended amount.
• Stabilising on an equivalent dose of diazepam for a few days before dose reduction, if patients were using higher than recommended doses or finding it difficult to reduce the dose of a short-acting benzodiazepine (avoid diazepam in older people).
• If multiple benzodiazepines are used, the dose of each drug may be reduced one after the other.
O-ngoing review and use of non-drug therapies
• Monitor the effect of stopping or reducing use on sleep patterns, mood, withdrawal symptoms and use of other substances (e.g. alcohol, nicotine): aim initially for weekly review.
• Encourage ongoing use of non-drug therapies to manage insomnia and to help with maintaining cessation or reduction in