Aims In 2012–2013 melatonin prescriptions cost our Paediatric department over £45,000 per year. An audit was carried out to explore the practice of prescribing melatonin among clinicians, compare it with current evidence for melatonin prescribing and find cost effective ways of reducing the annual melatonin spend.
Methods Families of children with neurodevelopmental disorders issued with melatonin from hospital or community pharmacies from January to June 2013 were included in the audit. Cases were randomly selected and case-notes and doctor’s reports audited retrospectively. Children on melatonin for less than 6 months were excluded from the study.
Results A total of 17 case-notes were audited. A detailed sleep history was documented in merely 1 case. Only 12% of cases were given verbal advice on sleep hygiene, prior to starting melatonin, and received sleep support whilst on melatonin. Paediatricians requested sleep hygiene support from Primary care in 6% of children. A sleep-diary was never used to monitor sleep at any stage of management. Children taking melatonin ranged from 1 to 8 years, with one child on melatonin for 12 years. Paediatricians did not suggest breaks from therapy in all cases. Given dosages of melatonin were ranged from 2 mg to 12 mg.
Conclusion This audit highlighted the need for the development and implementation of evidence-based melatonin guidelines for Paediatricians, a sleep tool-kit for health professionals to help conduct a more effective sleep interview and sleep information to help support families establish good sleep hygiene in their children. So far, a melatonin guideline and sleep support tool-kit has been developed and circulated to relevant stakeholders. This has resulted in better prescribing practice, sleep support for families and a reduction in melatonin prescribing. Following the introduction of the guidelines, the preliminary results on the melatonin expenditure concluded a cost saving amount of £5651 over a period of 5 months, April to August 2014, compared to the same time period in 2013. These initial results are quite promising in predicting a larger saving in the future.
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