Protocols

The Neurophysiology department at Great Ormond Street Hospital (GOSH) intends to publish all its current protocols in this section.

• melatonin-induced sleep recording 

• sleep deprivation
• prescribing melatonin

1. Sleep EEG request received by the EEG department.    
2. The EEG secretary sends a letter of invitation to the parents/carers to call the department to arrange an appointment for the EEG, together with the information sheets on the use of melatonin for sleep EEG and sleep deprivation EEG. It will be requested that the parents/carers read these documents carefully and state their preference by signing and returning the consent form.    
3. On telephone booking of the EEG, the secretary will be informed of the parent’s choice for sleep EEG and will send the standard pack containing
   
   1. information on video recording
   2. the activation procedures during EEG
   3. a map of the hospital            
4. The patient and parents/carers will arrive at the EEG Department at GOSH. The physiologist will explain the procedure in more detail and establish that all the consent forms have been signed. If the patient requires melatonin the physiologist will direct the family to Starfish Ward to obtain the melatonin.    
5. Melatonin is stored in the controlled drug cabinet on Starfish Ward. The responsibility for the prescription of melatonin is handled by the duty epilepsy registrar (bleep 0584).     
6. The melatonin administration book on the ward must be completed.  The nurse on the ward will administer the melatonin and sign the book, recording the date and time.      
7. Melatonin is available in 3mg capsules and may be dissolved in water, milk or juice.  The following dosage regimen should be followed:
   
   1. Melatonin < 5yrs  = 3 mg
   2. Melatonin > 5yrs  = 6 mg
   3. Children over the age of 5 years who fall within the autistic spectrum disorder (ASD) group are likely to need a higher dose of 9 mg
   4. In exceptional circumstances, a dose of 12 mg may be administered            
8. The patient and parent are then re-directed to the EEG department in order for the patient to have the EEG examination.    
9. Following the EEG the child should be woken and allowed home after a drink.
Should there be concern, the EEG technician should page the epilepsy registrar on 0584.  If the child appears to be too sleepy they will be kept in hospital until considered fit to go home.

This procedure is used to obtain sleep the following day when: 

• The parents/carers do not wish the child to have melatonin.
• The child has already failed to sleep with melatonin.
• The probable diagnosis is one of juvenile myoclonic epilepsy, a condition in which sleep deprivation is known to promote EEG abnormalities.
• There are other medical indications.

1. The parents/carers are asked to keep the child up for at least two hours past their usual bed-time.
2. They are then asked to awaken the child at least 1-2 hours before they are usually roused.
3. The child then spends the morning at their usual activities and is not allowed to nap.
4. The child is then brought for their EEG appointment after lunch.
5. The EEG electrodes are applied in the usual fashion.
6. The child is laid down on the bed and encouraged to fall asleep.

The prescribing doctor must fill out the first six columns of the melatonin book. This is the date of prescribing, signature and print name of the doctor, date of birth of the patient, hospital name, patient name and the dose to be given.

Leave a line between each patient.

Prescribe for all patients coming in on Tuesday that week till the following Monday.

The melatonin book should be given to your ward pharmacist once a week on Monday. Your ward pharmacist is Jayesh Shah on Mondays, Tuesdays and Fridays, and Maiee Ahmed on Wednesdays and Thursdays. You can also contact them on bleep 0811 or on extension 7893.

The screening pharmacist will check the doses and ensure the prescription is valid. The pharmacist will complete a transcription sheet and endorse the last column in the book, with the amount given and their signature. Screening can take place on the ward or in pharmacy. If the book is bought to Pharmacy it must be sent back to the ward quickly, as they will need it to administer the drug.

Dispensing will be from the transcription sheet, following the dispensary procedures.

Once the product is checked it can be placed in Starfish Rapid Assessment Neurology Unit's (RANU) pigeon hole to send to the ward by the porters.

The product will be stored in the drug cupboards on Starfish. It must only be used for sleep EEG patients, and not for patients on the ward.