TO SLEEP PERCHANCE TO DREAM; A NURSE–LED QUALITY IMPROVEMENT PROJECT TO PROMOTE NON PHARMACOLOGICAL MANAGEMENT OF OLDER PERSON INSOMNIA

Abstract Ref: 
0039

Florence Horsman Hogan1,2, Michelle Anderson1, Adrian Ahern1, Joepeph Yazbeck1
1Leopardstown Park Hospital, Dublin, Ireland
2Royal College of Surgeons, Dublin, Ireland

Background: In the residential care setting, nurses are to the forefront of resident care
and are thus essential to effective assessment and management of insomnia and avoidance
of potentially inappropriate prescribing of Hypnotic Medication (HM). Many residential
care facilities do not have a resident Medical Officer, which presents a challenge
to ensuring consistency of practice.
Impaired sleep quality can result in harmful effects on mental and physical well-being.
Insomnia (difficulty with initiating or maintaining sleep) is a highly prevalent condition:
research varies for the older person but averages between 39 – 49%. However clinically
significant insomnia occurs in just about 10% of the population. While there may be
beneficial effects in the short term, the evidence shows that HM has adverse effects, particularly
in the older person as it exacerbates Dementia related symptoms and Frailty.
In our organisation 36.4% (43) of the residents were prescribed Hypnotic Medication
(September 2016). There was no evidence of a formal diagnosis or treatment plan in relation
to insomnia for these residents either on admission or when HM was first
prescribed.

Methods: To give the nurses the skills required, an education programme was delivered
by the (Nurse) Quality and Patient Safety Manager and Chief Pharmacist. Subject matter
was recognition of insomnia, management of insomnia through Sleep Hygiene techniques,
effects and side effects of HM, including implications of long term use. The onus
on the Nurse to use evidence based practice and ethical issues in relation to informed
consent in relation to Dementia were highlighted.

Results: Residents Prescribed HM
October 2016 43 = 36.4%
October 2017 18 = 16.6%
April 2017 11 = 10%

Conclusion: Nurse’s knowledge of how to effectively manage insomnia is imperative to
ensuring that HM is appropriately prescribed and reviewed for discontinuation. Education
is evidenced to improve non-pharmacological treatment and decrease prescribing rates.