Prescribing practice and policy for hypnotics: a model of pharmacy audit

A problem of overprescribing of hypnotic medication ('sleeping tablets') was identified and quantified within a department of health care for older people in a district general hospital. Data on the volume of prescribing were obtained from computerized pharmacy records, and this information was supplemented by a retrospective survey of case notes of 100 patients. Sixty per cent of patients were prescribed a hypnotic at some stage during their hospital stay. Twelve per cent were prescribed a sleeping tablet on admission on an 'as required' basis but never took this medication, suggesting that such prescribing was becoming routine. As part of an ongoing pharmacy audit within the department, a policy was implemented to try to improve prescribing habits. Following this, hypnotic prescribing fell, with the average monthly number of sleeping tablets prescribed falling from 2392 to 734. A further survey of 100 case notes showed overall prescribing had fallen to 25%, although 2% were still prescribed a hypnotic on admission but never took it.