Melatonin use in an inpatient academic medical center: Factors affecting provider documentation of patients' sleep quality.

Objectives: Melatonin is commonly prescribed for insomnia despite the 2017 American Academy of Sleep Medicine recommendation against its use due to lack of evidence for efficacy and information on adverse effects. The objectives of this study were to determine what percentage of prescribers document the impact of melatonin on sleep quality in hospitalized patients and to examine factors influencing provider documentation.

Methods: In this single-center retrospective study, electronic medical records of 200 adults with orders for melatonin over a 6-month period were reviewed. The primary outcome was to evaluate provider documentation of sleep and the impact of melatonin on patients' reported sleep quality. Secondary outcomes included an evaluation of provider medication reconciliation (admission/discharge) and concomitant insomnia therapy. Descriptive and inferential statistics were performed (V13.1 Systat Software, Inc.). P values < 0.05 denoted significance.

Results: Providers documented overall sleep quality for 65 (32.5%) patients (15.47 ± 29.23, range 5 to 100%). Specific mention of melatonin's impact on sleep quality was available for 16 (8%) patients. Fifty-four (27%) patients received melatonin prior to admission, and 73 (36.5%) continued therapy at discharge. For patients discharged on melatonin, the percentage of provider documentation related to patients' sleep quality was higher compared to those discharged without melatonin (41.1% vs. 27.6%; P < 0.049). Fifty-nine (29.5%) patients had concomitant insomnia medications. Provider documentation was greater for patients receiving combination therapy (44.1%) compared to melatonin monotherapy (27.7%; P < 0.024).

Conclusion: Documentation of patients' reported sleep quality was lacking for 67.5% of patients. Prescriberswere more likely to document impressions of patients' sleep quality when the patients received melatonin in combination with at least 1 other medication for insomnia. Melatonin was continued upon discharge for an additional 9.5% of study patients who had not been taking melatonin prior to admission. This study demonstrated that melatonin is widely used but narrowly monitored.