Veterans Administration San Diego Healthcare System
DATE:
FROM:
Ben Dishman Pharm.D. BCPP
SUBJECT:
SCOPE OF
SPECIALIST
THROUGH:
Chief, Pharmacy Service
TO:
Pharmacy Service, Professional Standards Board
PRACTICE
FOR
PSYCHIATRIC
CLINICAL
PHARMACY
BACKGROUND
Pharmacy Service has established multiple psychiatric outpatient clinics. Pharmacy Service now
provides the following psychiatric clinics: Cognitive Disorders Clinics, Mood Disorders Clinics,
Psychiatry Emergency Clinic, Geropsychiatry Clinic, Sami, and a Clozaril Clinic. The pharmacists
working within these clinics must possess expertise in the symptomatology of psychiatric
disorders, and clinical psychopharmacology, with the ability to evaluate patient response to
therapy, recognize adverse drug reactions to psychotropic medications, and make appropriate
changes in therapy.
In order to operate efficiently and independently in the above mentioned clinics, a specific scope
of practice has been defined by which the Psychiatric Clinical Pharmacy Specialists perform their
duties.
PURPOSE
To define the specific scope of practice necessary to perform the duties of the Psychiatric Clinical
Pharmacy Specialist and to define the necessary background and training requirements.
BACKGROUND AND TRAINING
A Psychiatric Clinical Pharmacy Specialist must possess the following background and training:
1)
2)
3)
4)
Pharm.D. degree or equivalent,
Completion of a pharmacy residency program or equivalent experience
At least one year of clinical experience in psychiatry,
Ability to demonstrate appropriate clinical skills to the Psychiatric Clinical Pharmacy
Specialist supervisor and to the Chief of Psychiatry Service.
CLINICAL PRIVILEGES
In order to perform the duties of a Psychiatric Clinical Pharmacy Specialist, the following scope of
practice is required:
1) Assess clinical response, through utilization of the mental status exam and psychiatric
interviewing techniques.
2) Assess the development of adverse drug reactions (i.e., extrapyramidal reactions;
anticholinergic effects; lithium, carbamazepine, valproate toxicities; benzodiazepine
dependence and withdrawal; and tardive dyskinesia).
3) Order and evaluate appropriate laboratory tests to assess clinical response, development of
adverse drug reactions, therapeutic drug levels, and complete all appropriate clinical
reminders.
4) Make changes in psychotropic drug therapy utilizing the Physician Order Form or through
direct order entry into the computer. Dosage changes or discontinuation of medications may
be made. Changes in medications within the same general class of drugs will be allowed.
The addition of routine medications to treat adverse effects will be permitted (i.e.,
anticholinergics). The initiation of a medication for a new treatment indication will be
approved and countersigned by a physician (psychiatric resident or attending).
5) Assess patient compliance with medications by analyzing computer dispensing records and
quantities of medications dispensed verses doses remaining.
6) Document the findings, actions, and plans in the patients’ medical records on the Progress
Notes Form or through direct progress note entry into the computer.
7) Provide prescriptions for all medications with enough medications to last until the patients’
next clinic appointment(s).
8) Provide patient medication education, including methods of coping with certain side effects,
recognizing symptoms of toxicity, and emphasizing the importance of compliance. When
appropriate, provide written drug information.
9) Reschedule the patient for further follow-up appointment(s) with the appropriate individual(s).
10) Supervision of these clinical privileges shall be carried out by the psychiatry service and
requires a psychiatrist to be available in person or by telephone for consultation.
11) If a pharmacist wishes to initiate a change in therapy which requires a change in diagnosis or
change in class of medication a psychiatrist must be contacted and must cosign the
electronic chart note.
12) Assure, all patients are seen by a psychiatrist at least once per year.
___________________________
Ben Dishman, BS. Pharm, Pharm.D., BCPP
Psychiatric Clinical Pharmacy Specialist
___________________________
Chief, Psychiatry Service
___________________________
Staff Psychiatrist, Mood Disorders Clinic
____________________________
Chief, Psychiatric Emergency Clinic
____________________________
Chief, Mood Disorders Clinic