Re-Audit of Discontinuation Plans on Discharge for Prescribed Hypnotics in General Adult Inpatient Services

TL;DR

This study found that only 18.75% of patients discharged from psychiatry wards had specific hypnotic discontinuation plans, but improvements were seen after implementing changes.

Contribution

The study demonstrates the effectiveness of implementing changes to improve documentation of hypnotic discontinuation plans in discharge summaries.

Findings

Only 18.75% of discharge summaries included a specific hypnotic discontinuation plan.

A re-audit showed significant improvement in compliance with recommendations after changes were implemented.

Strict adherence to guidelines is needed to achieve full compliance and reduce hypnotic risks.

Abstract

Aims: Assess the number of patients discharged from General Adult Psychiatry wards with hypnotics prescribed for insomnia.

Evaluate the consistency of documenting discontinuation plans for hypnotics in discharge summaries.

Methods: We conducted a retrospective review of 24-hour discharge summaries for patients discharged from six adult inpatient general psychiatry wards between 15/01/2024 and 15/04/2024. The review focused on patients prescribed regular hypnotics for insomnia, specifically analysing the “Instructions to GP” section to determine whether a specific discontinuation plan was recommended or advised. This was done by reviewing our online database used within the trust.

Results: In the current audit, 56.25% of the sample had discharge summaries that included a medication review for hypnotics suggested to the GP, while only 18.75% included a specific discontinuation plan for hypnotic medication. A previous audit conducted in 2023 on two adult inpatient general psychiatry wards demonstrated 0% compliance, with no discharge summaries containing a medication review for hypnotics or a specific discontinuation plan. Following the implementation of changes, a re-audit in 2024 on the same wards showed significant improvement, with 66.6% of discharge summaries including a medication review for hypnotics and 33.3% containing a specific discontinuation plan for hypnotic medication.

Conclusion: The previous recommendations have led to noticeable improvements; however, strict adherence to these recommendations is necessary to achieve the target of 100% compliance. It is crucial for the inpatient General Adult Psychiatry team to consistently communicate a specific discontinuation plan for hypnotics to the GP. This practice is essential to reduce the risk of dependence and minimize potential side effects associated with hypnotic medications.