Facilitating Deprescribing of Benzodiazepines and Hypnotics on Adult Mental Health Wards

Lanchester Road Hospital; Tees, Esk and Wear Valley NHS Foundation Trust

Project summary

A multi-disciplinary (MDT) approach aimed at encouraging deprescribing of benzodiazepines, when needed anxiolytics and hypnotics prior to discharge on two, 20 bed, adult mental health wards, one male and one female.

This project rang alongside a master’s degree completed by our ward pharmacist with Aston University, entitled Facilitators and Barriers to the Deprescribing of Benzodiazepines and Z-drug hypnotics in patients under 65 on Adult Mental Health Wards. This highlighted that there was very little research into this, and by interviewing healthcare practitioners from around the country the masters research enabled good practice to be captured into final report, which was published in November 2025 in Scientific Reports. As a MDT, we then set about implementing some of the areas highlighted in this research into a multipronged approach to deprescribing. While we acknowledge that in the mental health setting, benzodiazepines, anxiolytics and hypnotics are often appropriately prescribed in line with treatment plans, our project looked at deprescribing once these medications were no longer indicated.

Weekly prescribing review meetings were introduced and prioritised on both wards, where regular and “when required” are reviewed and reduced if appropriate. Reviews are attended by senior medical staff, junior medical staff and pharmacists, who then discuss potential changes with patients and involve them in plans to reduce use prior to discharge. EPMA systems are used to record reviews.

Nursing staff led on changes to lighting overnight, highlighting which lights could be safely turned off to aid sleep. Sleep packs were also introduced which are given to patients to support good sleep. Patients were supported by the activities coordinator to make posters to promote good sleep hygiene on the ward.

Resident doctors audited reviewing of “when required” medication on the wards, presented their findings to the MDT, and then reaudited a year later. Overnight prescribing of “when required” medication by on-call medics is reviewed every morning in the MDT report out, to ensure that these medications are indicated and appropriate in the first place.

Training for the full MDT on sleep was led jointly by a psychologist and a pharmacist.

The result has been a large and sustained drop in prescribing of benzodiazepines, hypnotics and promethazine at discharge.

The positive outcomes for patients are that they are prepared for discharge from the adult mental health wards confident that they have been managing without benzodiazepines, hypnotics and promethazine on the ward. They also avoid potential withdrawal effects from stopping these post discharge.

This project had no additional costs and although small savings will have been made around reducing prescribing of these medications, the aim was to improve the quality of prescribing in the build up to discharge.