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Abstract
Intro Melatonin is widely used off licence in children and young people with an evidence base for delayed sleep phase syndrome but only modest impact as a hypnotic. We reviewed national and regional prescribing data and undertook a detailed review of all melatonin prescriptions issued to those under the age of 18 within one of the UK’s largest dedicated paediatric hospitals, this included cost analysis. This was aimed at understanding whether prescribing was appropriate, whether alternative behavioural therapies had been recommended and whether there had been consideration of other causes of poor sleep.
Method All melatonin prescriptions issued from the hospital for patients under the age of 18 over a year were measured. We assessed whether prescriptions were issued in accordance with local Melatonin Shared Care Guidance standards¹ that emphasise fixed timing and review of benefit. This included reviewing all electronic patient care records.
Results Adherence to the standards outlined in the shared care agreement were not being met. There was a difference between prescriptions issued by the community team versus inpatients, outpatient prescribing had better documentation about discussions regarding breaks and reviewing the dose. See table 1. Total costs of prescriptions £13,299.16; the majority of this was for oral suspension (£8730.34), this should be third line and not issued to children under 5years.1
Documentation of key shared care recommendations
Discussion The evidence base for melatonin highlights the importance of advice around timing, behavioural intervention and review of ongoing need and benefit. The audit highlighted a lack of knowledge about melatonin and led to a trust wide sleep education programme. While well tolerated for many, there is a cost to inappropriate prescribing. There is a clear need for better access to behavioural interventions and better support for carers with education, information and support.
Reference
http://www.northoftyneapc.nhs.uk/wp-content/uploads/sites/6/2021/07/Melatonin-Shared-Care-June-2021.pdf?UNLID=3666073762022127193353 North of Tyne, Gateshead and North Cumbria Area Prescribing Committee Melatonin for the management of Sleep-Wake Disorders In Children and Young People. Accessed May 2023
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