Appendix C. Detail on criteria for audit of the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia | Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia | Guidance

Possible objectives for an audit

An audit could be carried out on the appropriateness of use of zaleplon, zolpidem and zopiclone.

Possible patients to be included in the audit

An audit could be carried out on all patients treated for insomnia for a suitable time period for audit, for example, 3–6 months. Alternatively, an audit could be carried out over a suitable time period, for example, 3–6 months, on all patients for whom hypnotic drug therapy is prescribed.

Measures that could be used as a basis for audit

The measures that could be used in an audit of zaleplon, zolpidem and zopiclone for the management of insomnia are as follows.

Criterion	Standard	Exception	Definition of terms
1. Non-pharmacological measures are considered before then prescription of drug therapy for insomnia.	100% of patients being treated for insomnia.	None	For audit purposes, clinicians will need to agree locally on how non-pharmacological measures are defined and how consideration of their use is documented.
2. When hypnotic drug therapy is used, the drug used is prescribed for a short period of time only, in strict accordance with the licensed indications	100% of patients for whom hypnotic drug therapy is prescribed	None	Drug therapy for insomnia can include zaleplon, zolpidem, zopiclone or the shorter-acting benzodiazepine hypnotics (loprazolam, lormetazepam and temazepam). For audit purposes, clinicians will need to agree locally on how to define the duration of a prescription. The maximum duration of a prescription for zaleplon is 2 weeks and for zolpidem and zopiclone is 4 weeks. Also for audit purposes, clinicians will need to agree locally on how to define and measure the consistency of prescriptions with licensed indications for each drug.
3. When hypnotic drug therapy is prescribed, the drug with the lowest purchase cost is chosen	100% of patients for whom hypnotic drug therapy is prescribed	A. The patient experiences adverse effects considered to be directly related to the firstline choice	The lowest purchase cost takes into account the daily required dose and the product price per dose. For audit purposes, clinicians will need to agree locally on the source of cost information and on how adverse effects of a specific drug are documented.
4. A patient is switched from one hypnotic drug to another	0% of patients for whom hypnotic drug therapy is prescribed	A. The patient experiences adverse effects considered to be directly related to a specific agent	Clinicians will need to agree locally on how adverse effects of a specific drug are documented for audit purposes.

An audit on all patients for whom hypnotic drug therapy is prescribed could be carried out using the measures above.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed	x 100
Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.