Recommendations for organisations

Consider the prescribing advice within this document alongside local prescribing and clinical data; positions and trends, to plan, resource and drive quality improvement and prescribing initiatives.

Nominate local leads/champions – one medical and one within, or with strong links to, medicines management teams or equivalent – to drive delivery and recommendations within this document.

Consider and engage a whole system approach to delivering quality improvements in prescribing:

• Ensure primary and secondary care are informed, to support continuity of care and overall goals of reviewing and minimising inappropriate prescribing. Recognise the significant influence of secondary care in prescribing behaviour. HSCPs should consider locality work targeting B-Z prescribing.
• Work with third sector (non-medicalised) organisations to further develop and support the capacity for self-management.
• Develop capacity to support individuals and services.

Where B-Z cannot be stopped before discharge, secondary care should establish and communicate a reduction plan for B-Z prescriptions started in hospital.

Where appropriate, hospitals should develop and implement a ‘no hypnotic on discharge policy’ for B-Z initiated in hospital.

Individuals within care homes should be identified for proactive review to ensure that any B-Z medicines prescribed have an appropriate indication and are prescribed at the lowest therapeutic dose to achieve the desired effect and reduce the risk of harm. Sleep disturbance affects 38% of care home residents living with dementia,⁶² who are often treated with medication where non-pharmacological interventions may be safer and effective.^63,64 Despite the challenges to implementation of non-pharmacological interventions, these should be considered as alternatives to prescribing in care homes where appropriate.

Engage with local prescribing support teams, who have a wealth of experience improving the quality of prescribing through use of local and national measures, datasets and tools.

Consider developing and implementing general practice or cluster policies, that include key principles (see Resources - Practice policy example). This may help to reduce ‘doctor shopping’ within localities as all practices will be applying the same policy.