We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.
Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
If, after consideration of the use of non-pharmacological measures, hypnotics are considered necessary, limit their use to short periods of time only (1 to 4 weeks). Establish cause of insomnia. Be aware of drug and alcohol use and educate on realistic sleep patterns. Patient information leaflets are available from www.moodjuice.scot.nhs.uk. In most cases, hospital patients should only be discharged home with a supply of hypnotics if they were admitted on them and there is good reason to continue. This is particularly important for older patients. The use of hypnotics with a long half-life such as nitrazepam (non-Formulary) is not recommended as they often result in a hangover effect and may lead to accumulation, particularly in older people. Sedative antihistamines are not recommended.
Long-term hypnotic use is associated with falls, road traffic accidents and hip fractures. NHS Highland guidance on Insomnia is under development, for further information see: BNF: Hypnotics and anxiolytics.
Be aware or gain reassurance that the person being prescribed benzodiazepines is not diverting or purchasing/acquiring medicines privately.
NICE guidance April 2004 (www.nice.org.uk) recommends that switching from one hypnotic to another should only occur if a patient experiences adverse effects thought to be directly related to a specific agent. Patients who have not responded to one hypnotic should not be prescribed any of the others.
For information on the use of melatonin in children and adolescents see Sleep pathway (Paediatric Guidelines).
Additional information is available via the following links:
MHRA advice: Zolpidem: risk of drowsiness and reduced driving ability the next day (December 2014) (www.gov.uk)
Tablets 5mg, 10mg
10mg at bedtime. Older or debilitated patients 5mg at bedtime.
Tablets 3·75mg, 7·5mg
7·5mg at bedtime. Older or debilitated patients initially 3·75mg at bedtime increased if necessary.
MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)
Tablets 10mg (CD schedule 3)
10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.
Oral solution 10mg/5mL (CD schedule 3)
10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.
Tablets 3mg (specialist recommendation only)
Ceyesto brand is the cost-effective choice. It is licensed for: Insomnia in children and adolescents aged 6-17 years with ADHD, where sleep hygiene measures have been insufficient.
To be used for sleep onset difficulties in children as per Sleep pathway (Paediatric Guidelines).
In swallowing difficulties the tablets can be crushed and mixed with a small amount of water or soft food for administration.
For patients with enteral feeding tubes, a polypharmacy review should be conducted and, if melatonin is to be continued, advice from the Community Paediatrician should be sought for suitable formulations. See Highland unlicensed/off-label medicines list.
Oral solution 1mg/ml off-label
Sleep onset difficulties for patients with enteral feeding tubes in line with TAM guidance.
TAM (Treatments and Medicines) NHS Highland