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General and Risk Management, Patient Safety (including: medication errors, quality control)
The effect of pharmacist intervention on psychotropic prescribing through clinical medication review in a long-term care hospital in Dublin
  1. L.S. Conlon,
  2. R. Romero-Ortuno,
  3. B. Smyth,
  4. R. Ryan,
  5. L. Cogan
  1. 1Royal College of Surgeons, Pharmacy Dept, Dublin, Ireland (Rep.)
  2. 2The Royal Hospital Donnybrook, Medical Dept, Dublin, Ireland (Rep.)


Background The existence of psychotropic polypharmacy is well established and its detrimental effects on patients in long-term care are irrefutable. In 2009, 88% of long-term patients in the Royal Hospital Donnybrook were on at least one psychotropic medicine, with 59% on three or fewer and 25% on four or more. This level of consumption coupled with a high rate of observed adverse consequences was not conducive to optimum pharmaceutical care. Pharmacists have been shown to be an essential resource for optimum medicines use and safety and play a vital role in influencing prescribing. Consequently, a medicines review by the pharmacist has been implemented in collaboration with the prescribers.

Purpose The objective was to modify psychotropic prescribing through pharmacist intervention via the clinical medicines review, in order to reduce patient morbidity and increase the quality of life.

Materials and methods Clusters of patients were chosen for the medicines review sessions based on status decline or length of stay. The pharmacist acquired the patients' drug regimen prior to the meeting to facilitate preanalysis. The prescribers and clinical nurse manager then joined the pharmacist on the ward where medical notes and labs were reviewed. The pharmacist conducted a clinical review and made appropriate recommendations from evidence-based guidance such as NICE, STOPP-START and Beers Criteria. These were suggested and substantiated in an attempt to modify patient-specific psychotropic prescribing.

Results Prescribers implemented the majority of recommendations and psychotropic polypharmacy reduced, which infers a tangible transformation in psychotropic prescribing practice. Anecdotal evidence has demonstrated an improvement in morbidity with positive changes in the physical status and behaviour of most patients. An audit revealed a significant reduction in the number of psychotropic drugs prescribed per patient (from 2.3 to 1.7, p<0.002) and also a decrease in the total number of medicines per patient (7.1 to 6.0, p<0.003) reflecting a decline in side effects suffered. The effect of the intervention has been reinforced by a reduction in the level of admissions to acute care.

Conclusions The effect of pharmacist intervention on psychotropic prescribing through clinical medicines reviews have had an unambiguous impact on the medicines burden of long-term patients in this hospital. This initiative accentuates the value of the clinical pharmacist review and the effectiveness of pharmacist collaboration with prescribers in optimising pharmaceutical care.

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