Pharmacist ‘intelligent’ referrals to a liaison psychiatry team

Abstract

Antipsychotic medications are associated with an increased risk of falls, delirium and cerebrovascular events; and all can cause death (1-7). It is crucial that patients prescribed these agents receive regular specialist review to optimise therapy and prevent harm (8, 9). When antipsychotic prescribing in an acute hospital was investigated, it was found that only a third of patients on these agents were reviewed by the hospitals psychiatry team (8, 10, 11). A novel pharmacist referral system was developed to establish whether pharmacy could help improve patient’s access to psychiatric services to facilitate medication review. 345 patients (44%, n=345) were reviewed by a pharmacist and 152 (44%) referrals made. Nearly half (n=69, 20%) of the referrals were generated by a pharmacist using the newly implemented system. Pharmacy referrals focussedon medication safety, this was different to those generated by medical staff whose emphasis was on symptoms and behaviour. In addition to referrals the pharmacists were found to have a clinical impact on patient care in an additional 91 (26%) patients. The adverse consequences (ADRs) of antipsychotics were implicated in 45 patient admissions, confirming the real potential for patient harm. The pharmacist referral system identified the majority (n=39, 87%) of the ADRs. Following psychiatry review, 69% (n=31) of patient’s medication was adjusted following mental health assessment where both the patient’s mental and physical health needs were considered. The pharmacy referral service was found to enhance the clinical management of the vulnerable mental health patient in the hospital setting. It was an alternative to the traditional model of pharmacy in which clinical pharmacy services were targeted according to patient need rather than by physical ward location. Although, the model was demonstrated in mental health, it is felt that it could have a wider use according to the prescription of any high-risk medication.