McLellan Elizabeth Miriam, Haq Iram J, Ebdon Anne-Marie, Vasey Nicola, Anderson Kirstie N
Paediatric Department, Great North Children's Hospital, Newcastle upon Tyne, UK.
Department of Paediatrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
BMJ Paediatr Open. 2024 Dec 2;8(1):e002652. doi: 10.1136/bmjpo-2024-002652.
Melatonin is widely used to promote sleep in both normally developing children and adolescents and those with neurodevelopmental disorders. It has an evidence base as both hypnotic and chronobiotic although the optimum dose and timing remain unclear. There are now a wide variety of different preparations of melatonin both immediate and prolonged release. We reviewed annual national and regional prescribing data and undertook a detailed review of one year of melatonin prescriptions issued to those under 18 within one of the UK's dedicated paediatric hospitals, this included a cost analysis. This was to understand whether prescribing was appropriate, whether behavioural therapies had been recommended first and whether there had been consideration of other causes of poor sleep, such as sleep apnoea.
Between November 2020 and October 2021, 220 patients under 18 had one or more melatonin prescriptions issued to treat poor sleep. The audit assessed whether prescriptions were issued in accordance with local Melatonin Shared Care Guidance standards that emphasise: an initial behavioural approach, fixed timing, use of licensed preparations and review of benefit. This included a detailed review of electronic patient care records. A cost analysis of the different preparations was also made.Results adherence to the audit were not met for any of the audit standards, only 9% had a prior behavioural intervention, and only 15% had another sleep disorder considered. Community prescribers were more likely to give advice on timing and review any subsequent benefit. The total costs of prescriptions were £13 299 of which £8736 was issued as off licence, liquid suspension.
The audit highlighted a lack of knowledge about appropriate melatonin prescribing and led to a trust-wide sleep education programme. It additionally highlighted the cost and potential risk of inappropriate prescribing and a clear need for better access to effective behavioural interventions.
褪黑素广泛用于促进正常发育的儿童和青少年以及患有神经发育障碍者的睡眠。尽管最佳剂量和服用时间尚不清楚，但它作为催眠药和生物钟调节药都有证据支持。目前有多种不同的褪黑素制剂，包括速释型和缓释型。我们回顾了年度国家和地区的处方数据，并对英国一家专门儿童医院内发给18岁以下患者的一年褪黑素处方进行了详细审查，其中包括成本分析。这是为了了解处方是否合理，行为疗法是否首先被推荐，以及是否考虑了其他睡眠不佳的原因，如睡眠呼吸暂停。
在2020年11月至2021年10月期间，220名18岁以下患者开具了一张或多张褪黑素处方以治疗睡眠不佳。审计评估了处方是否符合当地褪黑素共享护理指南标准，该标准强调：初始行为方法、固定时间、使用许可制剂以及效益评估。这包括对电子患者护理记录的详细审查。还对不同制剂进行了成本分析。结果发现，所有审计标准均未达到，只有9%的患者有过先前的行为干预，只有15%的患者考虑过其他睡眠障碍。社区开处方者更有可能就服用时间提供建议并评估任何后续效益。处方总费用为13299英镑，其中8736英镑是无许可证的液体悬浮剂。
审计突出了对褪黑素合理处方缺乏了解的问题，并促成了一项全信托范围的睡眠教育计划。它还突出了不适当处方的成本和潜在风险，以及明显需要更好地获得有效的行为干预措施。
