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An Audit of Melatonin Use and Parental Satisfaction in a District General Hospital

An Audit of Melatonin Use and Parental Satisfaction in a District General Hospital. Dr Francine Toussaint Dr Anna Baverstock Musgrove Park Hospital Taunton. Summary of presentation. Reasons for audit Sleep physiology Melatonin and the evidence base for it Methods of study Results

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An Audit of Melatonin Use and Parental Satisfaction in a District General Hospital

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  1. An Audit of Melatonin Use and Parental Satisfaction in a District General Hospital Dr Francine Toussaint Dr Anna Baverstock Musgrove Park Hospital Taunton

  2. Summary of presentation • Reasons for audit • Sleep physiology • Melatonin and the evidence base for it • Methods of study • Results • Conclusion • Changes to practice

  3. Reasons for audit • Melatonin at risk of withdrawal from hospital formulary • Our aims • Audit current use of Melatonin in paediatric patients • To evaluate current evidence for use of Melatonin • Improve quality of care for children with sleep disturbance while balancing the need to reduce prescribing costs

  4. N1 N2 REM N3 Sleep cycle N2 N4 N3 Under ones 14-18hrs 1-3 years 12-15hrs 3-5 years 11-13hrs 5years + 9-11hrs Adult 7-8hrs Newborn Up to 18hrs Reminder of sleep physiology Sleep required:

  5. Sleep problems Can’t fall asleep Strange behaviours Problems staying asleep Daytime sleepiness Management options: Routine and sleep hygiene advice Sleep Solutions - Support for families of children with neurological conditions Cerebra - Support for brain injured children Medication Study of 1-2yr olds: 56% woke 1night/week 24% woke 2 nights 20% woke 5-7nights

  6. Can’t fall asleep Strange behaviours Problems staying asleep Daytime sleepiness Sleep problems Melatonin

  7. Methods Part 1: Review of letters on all patients identified • Basic demographics • Underlying diagnosis • Details of Melatonin and other medications • Other methods used • Perceived effectiveness of Melatonin Part 2: Patient/parent satisfaction questionnaire • Reasons for starting Melatonin • Perceived benefits • Side effects • Other strategies tried Resent x 1 to increase number of replies • August 2011: pharmacy records used to identify all paediatric patients with current Melatonin prescription

  8. Results Part 1 121 Patients Identified 110 Patients Analysed 2 duplicates 2 adults 7 procedures Patient Ages Patient Diagnoses 15-17yrs 14% <5yrs 11% ADHD 31% Other 37% 11-14yrs 36% 6-10yrs 44% ASD 32%

  9. Results Part 1 • Sleep latency most common reason to initiate Melatonin (75%) • 79% documented trying other strategies • Most commonly sleep hygiene • 60% of letters documented effectiveness of Melatonin

  10. Part 2 : Patient Satisfaction • 53% response rate • 98% felt Melatonin was beneficial • Improved sleep latency (50%) • Longer sleep (14%) • Improved quality of sleep (12%) • Improved daytime effects (12%) • 12% had side effects • 100% had tried other methods, 21% “everything” • 86% received advice/sleep strategies

  11. Part 2 : Patient Satisfaction It has transformed bedtimes Melatonin has literally been life changing Her concentration has increased and her mood swings have decreased I wish it came in a form suitable for children Now he is 18…our PCT won’t allow our GP to prescribe it I feel this should be available over the counter to everyone as it is in the USA I don’t like medication but no sleep has far worse side effects Without Melatonin our family would be destroyed.

  12. Data Collection • Used letters database only • 2 researchers involved in data collection • Potential bias

  13. Conclusion • Majority of patients on Melatonin are male with ADHD or ASD and sleep latency problems. • Vast majority notice significant benefits. • Doctors need to improve documentation.

  14. Changes to practice • Development of Guideline • Written sleep advice and sleep diary to be used initially • Then trial of Melatonin

  15. “Not being able to sleep is terrible. You have the misery of having partied all night…without the satisfaction” Lynn Johnston

  16. Thank you • Matthew Dean – Musgrove Park Audit Department • References • Gringras P When to use drugs to help sleep Arch Dis Child. 2008 Nov;93(11):976-81. Epub 2008 Aug 1. Review. • MENDS study (presented RCPCH April 2011, SW MCRN network Nov 2011)http://www.hta.ac.uk/project/1522.asp • Richman N Sleep problems in young children Arch Dis Child. 1981 Jul;56(7):491-3. - Ferber 1985 Solve you child’s sleep problems

  17. Questions? “People who say they sleep like a baby usually don’t have one” Leo J Burke

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