Shared learning database
Type and Title of Submission
Implementing NICE TA 77: Guidance on the use of Zaleplon, Zolpidem and Zopiclone for the Short-term Management of InsomniaDescription:
The main objective of this piece of improvement work is to implement NICE Technology Appraisal No.77Category:
ClinicalDoes the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
TA77 - Insomnia - newer hypnotic drugsCategory(s) that most closely reflects the nature of the submission:
Description of submission
The purpose of this abstract is to outline the mechanism used for the implementation of NICE Technology Appraisal 77. It describes how the Trust is working with its partners to transform the delivery of care in primary, secondary and community settings to improve access to services and produce consistently better outcomes for patients.Objectives
The main objective of this piece of improvement work is to implement NICE Technology Appraisal No. 77Context
In April 2004 NICE issued guidance on the use of Zaleplon, Zolpidem and Zopiclone for the short management of insomnia. The Trust's Ten Step NICE Implementation process was systematically applied to this piece of NICE Guidance (Annexure 1) and an Implementation Steering Group was formed to implement the guidance.Methods
Baseline audits were initially carried out in Prince Charles Hospital and St. Tydfil's Hospital in 2005; a poor compliance with NICE was evident with regards to the choice of hypnotic drugs as not using benzodiazepines. Draft guidance was produced and circulated for comments throughout Primary and Secondary Care. A re-audit was undertaken on 8th May 2006. Ratified results of the May 2007 guidance was displayed on the Trust intranet in August 2007, whereupon guidance was re-enforced to doctors, nurses and pharmacists. Subsequently, a re-audit was undertaken late 2007. Audit findings identified that only Z-drugs were used on the majority of wards throughout 2007, compared to 2006 results; this would mainly be due to the regular attendance of a duty pharmacist visiting ST. Tydfil's hospital. All patients receiving hypnotics on acute wards receive only Z-drugs, to which the percentage of patients had decreased. Audit results showed that the frequency of prn administration had decreased, i.e.: Dowlais ward had changed from 100% daily prescribing to 100% every 2nd/3rd night only. Results also identified that the percentage of patients receiving daytime sedating medication had also significantly reduced for 2007 compared to 2006. It was commented that hopefully, due to patients sleeping less during the day would lead to less problems during the night.Results and evaluation
The ISG are responsible for driving, monitoring and evaluating implementation of NICE Technology Appraisal 77. Annual monitoring through the Mental Health Clinical Audit Programme continues to demonstrate year on year improvement.Key learning points
All staff had worked tremendously hard in implementing the guidelines; doctors had made significant improvements to their prescribing practise and nurses had made significant improvements to their administration practise to challenge patients who request hypnotics.
View the supporting material
|Job Title:||National Guidance Facilitator|
|Organisation:||Cwm Taf NHS Trust|
|Address:||Prince Charles Hospital|
NICE handles personal information provided to the Institute in accordance with the Data Protection Act 1998. Find further details in our data protection policy.
This page was last updated: 29 September 2009