Objectives: Insomnia has an estimated prevalence of 30% in general population and its prevalence is higher among psychiatric patients. In 1987 a survey showed around half of psychiatric patients received a hypnotic medication. Also people with mental health problems have an increased risk of developing dependence on hypnotics. "Z-drugs" are benzodiazepine like medications and are used as primary pharmacological treatment for insomnia. They include zolpidem, zaleplon, and zopiclone. Zopiclone is not available in the US, although its active stereoisomer, eszopiclone is available. NICE guidelines recommend trying non-pharmacological interventions such as sleep hygiene prior to considering "z drugs." The symptoms, findings of evaluation, and the reasoning behind prescribing "z drugs" should be documented in medical and nursing notes. The maximum duration should not be longer than 2 weeks when "z drugs" were used. The aims of this study included: To review if 'z-drugs' were prescribed according to the NICE guidelines, whether "insomnia" was documented in patient charts or not, if other measures were tried before prescribing a "z drug," and if the reason for switch was documented, in case of switching from one "z drug" to another.
Methods: We reviewed all the progress notes and medication charts for a 6-month duration between January 1-June 30, 2010 for all of the inpatients (n= 74) in the 6 forensic wards at the Littlemore Hospital. We identified the patients, who were prescribed "z drugs" for insomnia, and reviewed their records.
Results: We found out that only 3 patients were prescribed "z drugs," which was zopiclone 7.5mg/day for all of three cases. All orders were for as needed basis use. Insomnia was recorded in medication charts, but not in the notes section. Non-pharmacological measures were tried in only one of the patients and documentation was found in one case, too. The maximum duration was not documented and there was no revision in original orders.
Conclusions: Based on our data the "z drugs" are rarely used in forensic units of Littlemore Hospital. The only prescribed one was zopiclone and it was used only for a couple of days. The documentation regarding use of those medications was rare and no case of switch to another "z drug" was found. Checking for the response to the treatment and conducting the study in general wards beside forensic units would have improved this study and provided more patients, who were prescribed those medications. The majority of forensic patients are on high doses of antipsychotics or rapid tranquilizers, which might help to cope with insomnia. We found that other than documentation the standards were followed by the Trust. As forensic patients were supervised at all times on-call doctors should be able to prescribe Z hypnotics, when needed. The use of sleep hygiene in treatment of insomnia should be encouraged for all patients.