The original aim of this project was to change the culture of anxiolytic and hypnotic prescribing at our Practice in order to reduce prescribing from the 100th percentile nationally to a level approaching the national median. But this aim was exceeded.
Being such an anomaly for this prescribing metric was cause for concern; the need to prescribe the benzodiazepine and Z-drugs with great care is well documented and the focus of much work for Practice country-wide.
This project began in March 2021, with most patient reviews occurred between April 2021 and April 2022. The challenge was vast. It felt vast. Momentum was built and maintained with a novel use of prescribing data, to set bite-sized goals, understand the clinic-time needed, and monitor progress. An approach which was pharmacist-led, time-resource lean and both evidence-based and patient-centred was developed.
To reduce benzodiazepines and anxiolytics effectively and safely, attention was placed in two areas: consultation skills and prescribing processes.
Key outcomes include: Anxiolytic and hypnotic prescribing fell from the 100th percentile nationally to the 48th percentile in 12 months The number of patients on high dose diazepam and above licensed dose of Z-drugs fell from 80 to 0 The number of patients prescribed benzodiazepine/Z-drugs in combination fell from 54 to 0Other outcomes include significant improvement in the frequency of benzodiazepine/Z-drug medication reviews, patient education on potential harms and sleep hygiene, and the quality of new initiation Z-drug prescribing. Adverse and unintended outcomes were also monitored.
The project is ongoing but now in a ‘maintenance phase’, with less time specifically allocated to it. It is now truly embedded. Overall anxiolytic and hypnotic prescribing has continued to fall to the 30th percentile nationally, reflecting a Practice-wide change in prescribing culture around benzodiazepine and hypnotic prescribing. Thus this project is able to show how a novel use of prescribing data and quality reviews has produced sustainable change.
