Aim To improve the management of sleep dyssomnia in a Paediatric Community setting through audit as part of a quality improvement project.

Background Dyssomnia is estimated to affect between 25%–40% of children less than 5 years of age.¹ Behavioural techniques are known to be effective but sometimes this is not sufficient in isolation.²Melatonin is often prescribed as an adjunct.

Methods The challenges faced in the assessment and management of sleep dyssomnia in a large, multi-ethnic and diverse city were audited by questionnaire. This was designed to discover current local practice in managing common sleep problems. The questionnaire was distributed to Community Paediatricians from all five bases.

Results 20/21 Clinicians responded. We see children frequently with sleep problems (11/20 see 5 or more children per week) and 19/20 routinely screen for sleep problems. There is considerable variability in screening as 8/20 ask a single question only. All doctors were aware of sleep hygiene and 19/20 felt confident in advising parents. However, only 6/20 routinely used a sleep diary to aid assessment. Currently there is no consistent approach in the use of melatonin and across the city there are variable resources available to support families.

Conclusion The management of dyssomnia is variable and we felt that there was an opportunity for improvement. Recommendations Our vision is to develop a streamlined sleep service. We have used the STEEP (Safe, Timely, Effective, Efficient, Equitable and Patient-centred) quality service improvement model to identify areas to target. We have designed parent information leaflets and a guideline has been written. Once the pathway has been initiated, we will re-audit to ensure that improvements have been made. This will be hugely beneficial for our patients and their families. As trainees, this is our first quality improvement project and continues to be a valuable professional development exercise.

References

1. Galland BC, Mitchell EA. Helping Children Sleep. Arch Dis Child 2010; 95:850-853

2. Appleton RE, Jones AP, Gamble C, et al. The use of MElatonin in children with Neurodevelopmental Disorders and impaired Sleep: a randomised, double-blind, placebo-controlled, parallel study (MENDS) Health Technology Assessment 2012; Vol. 16: No. 40