The impact of clinical pharmacy intervention in a psychiatric hospital

Effects of multidisciplinary teams and an integrated follow-up electronic system on clinical pharmacist interventions in a cancer hospital

Background The aim of drug therapy is to attain distinct therapeutic effects that not only improve patient's quality of life but also reduce the inherent risks associated with the therapeutic use of drugs. Pharmacists play a key role in reducing these risks by developing appropriate interventions. Whether to accept or reject the intervention made by the pharmacist is a relevant consultant's decision. Objective To evaluate the impact of electronic prompts and follow-up of rejected pharmacy interventions by clinical pharmacists in an in-patient setting. Setting Shaukat Khanum Cancer Hospital & Research Center, Lahore, Pakistan. Method The study was conducted in two phases. Data for 3 months were collected for each phase of the study. Systematic and quantifiable consensus validity was developed for rejected interventions in phase 1, based on patient outcome analyses. Severity rating was assigned to assess the significance of interventions. Electronic prompts for follow-on interventions in phase 2 were then developed and implemented, including daily review via a multidisciplinary team (MDT) approach. Main outcome measure Validity of rejected interventions, acceptance of follow-on interventions before and after re-engineering the pharmacy processes, rejection rate and severity rating of follow-on interventions. Result Of a total of 2649 and 3064 interventions that were implemented during phase 1 and phase 2, 238 (9%) and 307 (10%) were rejected, respectively. Additionally, 133 (56%) were inappropriate rejections during phase 1. The estimated reliability between pharmacists regarding rejected interventions was 0.74 (95% CI of 0.69, 0.79, p 0.000). Prospective data were analysed after implementing electronic alerts and an MDT approach. The acceptance rate of follow-on interventions in phase 2 was 60% (184). Conclusion Electronic prompts for follow-on interventions together with an MDT approach enhance the optimization of pharmacotherapy, increase drug rationality and improve patient care.

Drug-related problems and the clinical role of pharmacists in inpatient mental health: an insight into practice in Australia

BACKGROUND

Drug-related problems (DRPs) cause significant morbidity and mortality in healthcare. Clinical pharmacists have shown to reduce DRPs in the inpatient setting. In mental health the effects of clinical pharmacists on DRPs is relatively unknown.

OBJECTIVE

To explore the clinical role of inpatient mental health pharmacists and the factors affecting their role.

SETTING

Australian hospitals.

METHOD

Mixed methods. As the profile of the hospital mental health pharmacy workforce is unknown, surveys were distributed to all Australian hospitals with a pharmacy department. DRPs and recommendations were classified using an adaptation of the DOCUMENT system. In-depth semi-structured interviews were undertaken with members of the Society of Hospital Pharmacists Australia's Mental Health Committee of Specialty Practice.

MAIN OUTCOME MEASURES

Types of DRPs identified by mental health pharmacists, the recommendations made to address them and the rate at which these recommendations were implemented. As well as mental health pharmacists' views on the factors which affect their clinical role.

RESULTS

277 clinical interventions were reported by 47 mental health pharmacists, with 332 DRPs identified and 355 recommendations made. Drug interactions were the most commonly identified DRP (13.9 %). DRPs ranged in severity and likelihood of occurring. Changes to therapy accounted for the vast majority of recommendations (60.8 %), with the most common being change of drug (29.9 %). In total 91.8 % of recommendations were implemented. On average pharmacists estimated 56.1 % of their clinical interventions focused on psychotropic medication issues. Sixteen pharmacists were interviewed. Their relationship with the medical officers, time constraints and a gap in the evidence base to guide practice were identified as the major factors affecting their role.

CONCLUSION

Pharmacists play an important role in ensuring the quality use of medicines in inpatient mental health. However, significant factors need to be addressed to further expand clinical pharmacy services in inpatient mental healthcare in Australia.

A comprehensive review of the impact of clinical pharmacy services on patient outcomes in mental health

BACKGROUND

The importance of pharmacists in mental healthcare is starting to be recognised around the world. However few studies have focused on the evidence supporting pharmacist involvement in the inpatient mental healthcare setting.

AIM

Evaluate types of outcomes achieved and level of evidence supporting clinical pharmacy services in inpatient mental health settings.

METHODS

Medline, PyscINFO and International Pharmaceutical Abstracts databases were searched from January 1990 to March 31 2013. Studies were included if in an inpatient setting, published in English, and reported an intervention provided by a pharmacist or involving a pharmacist with a pivotal role in an intervention team. Data were extracted according to sample population and size, study design and outline, country, role of the pharmacist in the study, and the main results of the study. The level of evidence for each study was assessed using Australia's National Health and Medical Research Council's hierarchy of clinical evidence and results were categorised as having economic, clinical and/or humanistic outcomes.

RESULTS

Eighteen articles met the inclusion criteria. A range of pharmaceutical services provided by pharmacists in inpatient mental healthcare were identified. These services highlight the role of pharmacists as reviewers of medication charts, laboratory results and medication prescribing and as educators of patients and other health care professionals. Six studies included a control or comparison group and had pre and post intervention measures. These comprised of three randomised control trials, one historical control study and two case series post and pre-post tests, corresponding to evidence levels of II, III-3 and IV respectively. Seven studies reported clinical outcomes, two economical and one humanistic outcomes. One study reported both clinical and economical outcomes. Seven studies focused on impact evaluation measures.

CONCLUSIONS

Pharmacists provide a variety of services and play a significant role in inpatient mental healthcare. However, the level of evidence supporting these services is limited and the type of outcomes achieved is narrow.