Shared learning database

Cwm Taf NHS Trust
Published date:
September 2009

The main objective of this piece of improvement work is to implement NICE Technology Appraisal No.77

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

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. The main objective of this piece of improvement work is to implement NICE Technology Appraisal No. 77

Reasons for implementing your project

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.

How did you implement the project

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 Draft guidance was produced and circulated for comments throughout Primary and Secondary Care.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.

Key findings

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.

Contact details

Leanne Cunningham
National Guidance Facilitator
Cwm Taf NHS Trust

Secondary care
Is the example industry-sponsored in any way?