Hypnotic drugs in hospital. Evaluation of their use: From prescription to administration

In 2015, a French agency, Haute Autorite de sante (HAS), published recommendations for the use of hypnotic drugs. We evaluated the compliance with good practice in prescription and administration studying 3 hypnotics (lormetazepam, zolpidem, zopiclone) referenced in our establishment (psychiatry, rehabilitation, recuperative and long-term care) and melatonin (immediate release hospital preparation). Prescriptions were analyzed on a given day (dosage, length of treatment, prescription modalities). Night nursing practices were collected. Amongst 423 hospitalized patients, 105 had a hypnotic monotherapy, 3 an association melatonin/zopiclone and 6 a melatonin monotherapy. The most prescribed molecule was zopiclone (79%). Prevalence of hypnotic prescription was 25.5%. 17.6% of these prescriptions were for less than 28 days, 82.5% were at maximum dosage, 46.3% were in systematic mode and 53.7% in conditional mode. Amongst the 22 patients over 65 years old, only 8 received half hypnotic dose. Concerning the 9 prescriptions of melatonin, dosage varied from 3 to 9 mg, 1 was in conditional and only 1 specified terms of use. All 15 nurses met, adapt administration to the patient's bedtime. Five nurses have already woken up patients to give them hypnotics. The prevalence of patients with hypnotics is higher than the general French population (6.4%). HAS recommendations are not all followed: duration of prescription greater then 28 days, few dosage adaptations. Nurses generally respect hypnotic administration rules. Melatonin is not often prescribed and has no prescription or administration recommendations. Our results confirm the need to spread hypnotic and melatonin recommendations in health facilities. Hospital pharmacists can relay such recommendations.