What action was taken in X Surgery?

Please be aware that this will be a protocol of my research. I will give you a brief explanation the I will provide you my colleague work that I will do the same thing. I am going to implementing the intervention then looking in depth may be then interviewing the GPs (general practitioners) or patients who come to or did not come the office (doing it in structured manner). please have a look to these work down as I am going to select 2 practices to work with. I am providing my colleagues work just to give you an Idea about what can been done.
Hypnotic Audit & Review 2014/15 X Surgery

Practice prescribing of hypnotics & benzodiazepines is measured and compared at a local (prescribing performance) and a national (QIPP indicator) level.

Why Audit?

* Continuing concern over long term use (1)

* Taking a benzodiazepine and/or hypnotic was associated with double the risk of death from any cause compared with no prescription for these drugs. Dose-response associations were found and there were approximately 4 excess deaths linked to these drugs per 100 people followed for an average of 7.6 years after their first prescription. (2)

* Driving whilst under the influence of drugs is a significant cause of injuries and deaths on the road. (3)

* Patients are not always given appropriate information and advice on the risks associated with long term use (4):

* Tolerance & addiction

* Drowsiness, clumsiness, forgetfulness, confusion, impaired judgement

* Falls & fractures – in people older than 60 years, these drugs are associated with an increased risk of falling of between 50-70% in relative terms. (5)

* Association with increased risk of dementia and increased cancer incidence in those prescribed high doses (6)

How is usage measured? Hypnotic ADQ per STAR PU – This is a measure of the total quantity of Benzodiazepines and Z-drugs prescribed, weighted for age and sex of a practices population.

At the start of the project x Surgery was the 4th highest prescriber out of 50 East Berkshire practices. x Surgery Q2 (Oct-Nov 13) 2013/14 ADQ 461

What action was taken in X Surgery?

1. Practice meeting to agree course of action with all prescribers. A consistent message is vital for success and helps to prevent patients pressurising or singling out a particular GP.

2. Search – patients prescribed these drugs during April – July 2013.

* Exclusion criteria: Housebound, care/nursing home (reviewed separately by care home pharmacist & responsible GP) and palliative care patients; one off supplies e.g. for back spasm, fear of flying and for epilepsy treatment.

3. Analysis consistently shows that a simple letter intervention reduces benzodiazepine use in patients who have been using them long-term (7). Letter sent to remaining patients to:

* Explain concern over the patients long-term use of named hypnotic/s

* 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

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