DEPARTMENT OF PHARM
ACY
UNIVERSI
TY OF MA
LTA
PHARMACIST INTERVENTION IN PATIENT MONITORING IN A PSYCHIATRIC HOSPITAL
Maria Mamo, Lilian M. Azzopardi, Anthony Serracino-Inglott
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
email: maria.mamo.06@um.edu.mt
Department of Pharmacy University of Malta
INTRODUCTION
METHOD
Psychiatric patients are a high-risk patient
 A
‘Patient
Monitoring
Tool’
monitored to test for applicability
RESULTS
and practicality of the tool.
 Validation resulted in improvement of the
population posing several challenges for safe
consisting
and effective provision of pharmaceutical
Monitoring Guidelines’ guiding
monitored by another pharmacist
care. Psychotropic medications often have a
the pharmacist during patient
and the degree of agreement
low therapeutic index and polypharmacy is
monitoring
and
a
‘Pharmaceutical
Care
Issues
1
common. Pharmacists have the adequate
and
ability
to
influence
prescribers to alter prescribing practices thus
bridging gaps between research and practice,
for the documentation of any
evaluate
the
pharmaceutical
quality
care
provided
from
to
of
8
health
professionals.
 A pilot study was performed
ward-based
during which 10 patients were
Table 2: Categorisation of PCIs identified
pharmacists was measured to
in a Kappa value of 0.574 showing
captured
by
the
establish inter-observer reliability.
ward.
moderate
agreement
Pharmaceutical
Care
between
Issues
the
(PCIs)
identified by the two pharmacists .
 A quantitative analysis after the pilot
phase and categorisation of PCIs identified
care  The tool was implemented and
and to
patients in a psychiatric setting
benefit
of
panel
in a psychiatric setting.
evaluation was carried out after 4
weeks through a self-evaluation
questionnaire.
was
compiled
in
tables
1
and
2
respectively.
 Post-implementation
Total number of PCIs
Mean number of PCIs per patient
- Mean number of PCI in male patients
- Mean number of PCI in female patients
Range of PCIs per patient
- Range of PCI in male patients
- Range of PCI in female patients
evaluation
was
positive.
Frequency
Pharmaceutical Care Issues
(n=75)
Too many drugs for indication
7
Improper drug selection
13
Identified clinically significant interactions
15
Need for additional drug
5
Unclear/Unconfirmed indication
0
Inappropriate dosage form
0
Dose too low
Dose too high
Dosage regimen not frequent enough
Dosage regimen too frequent
Drugs given p.r.n. despite this practice not
being recommended
Drugs with slow titration
4
6
4
1
1
0
Untreated indication
0
Prescribing error (wrong or missing
information)
1
Others
18
Dosage
form n=0
Dose Selection n=16
To develop a ‘Patient Monitoring Tool’ to
 The tool is applicable and practical for use
two
issues
30 patients in an acute psychiatric
 Validation was carried out by a
layout and presentation.
 Inter-observer reliability testing resulted
care issues identified during this  The tool was then used to monitor
process was developed.
AIMS
determine
Documentation Sheet’ allowing
between the pharmaceutical care
tool with respect to comprehensiveness,
No of PCIs
75
2.5
3.08
2.06
0-7
0-6
0-7
Drug selection
n=40
competence
‘Patient  The same 10 patients were then
of:
Table 1: Quantitative Analysis of PCIs
Drug
effect
n=0
Logistics
n=1
Others
n=18
pharmacist services in this setting.
CONCLUSION
This study demonstrated that the tool proposed can be implemented in the psychiatric in-patient setting.
Pharmacist intervention in patient monitoring of psychiatric in-patients may lead to optimization of
patient care and safer use of medications. Integrating the pharmacist into the multidisciplinary health care
team and direct patient involvement may further enhance the value of such services.
REFERENCE
1. Rothschild JM, Mann K, Keohane CA, Williams DH, Foskett C, Rosen SL et al. Medication safety in a
psychiatric hospital. Gen Hosp Psychiatry. 2007;29:156-162.