Facilitators and barriers to the deprescribing of benzodiazepines and Z-drug hypnotics in patients under 65 on adult mental health wards

Abstract

There is a place for the use of benzodiazepines/z-hypnotics on adult mental health wards, but they are often continued beyond a length of time where they are beneficial. This can result in dependence and withdrawal effects if stopped. Timely deprescribing of these medicines is encouraged, but there is limited evidence available as to what can be a facilitator or barrier to deprescribing benzodiazepines/z-hypnotics on these wards. Semi-structured interviews, with twenty-nine NHS healthcare professionals from eleven different NHS organisations, involved in the use of benzodiazepines/z-hypnotics on adult mental health wards, were conducted and recorded on Microsoft Teams and transcribed. Themes were generated via thematic analysis on NVIVO software, informed by a grounded, inductive approach, to identify similarities and differences in participants perceptions. The four main themes identified from participants’ experiences were: Culture (shared values, beliefs and practices). Patient factors. Practical measures to facilitate deprescribing of benzodiazepines/z-hypnotics on adult mental health wards. Primary/secondary care interface. Deprescribing culture, rather than being led nationally, is more influenced by local factors. Some patient behaviour patterns can be a barrier to deprescribing but many of these can be overcome by promoting patient-centred care, allowing patients to feel involved and enabled to make informed decisions around their care. Access to non-pharmacological methods to de-escalate behaviour, promote wellbeing and improve sleep on adult mental health wards can support deprescribing. Cohesive multi-disciplinary team working aids deprescribing, but staff pressures can hinder this by reducing access to appropriately trained staff. Effective discharge planning is important but not always achieved. Good communication post discharge can facilitate continued deprescribing. Overcoming the barriers and developing the facilitators identified could improve benzodiazepine/z-hypnotic deprescribing on adult mental health wards. Changes to national NHS culture and priorities are required to influence local culture. Otherwise, deprescribing practices will remain greatly influenced by local factors on individual wards. Good practice exists but further research and funding is needed to disseminate this throughout the NHS.