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How to Utilize Your Pharmacist In the Inpatient/Hospital Setting

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Title: SGAs Author: Susie H. Park Last modified by: Julie A. Dopheide Created Date: 5/5/2003 9:30:27 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: How to Utilize Your Pharmacist In the Inpatient/Hospital Setting


1
How to Utilize Your Pharmacist In the
Inpatient/Hospital Setting
  • Julie Dopheide, PharmD, BCPP
  • Associate Professor
  • USC School of Pharmacy
  • dopheide_at_usc.edu

NAMI 2007 Annual Convention June 22, 2007
2
My experience.
  • Psychiatric Pharmacist specialist at LACUSC
    Inpatient Psychiatric service
  • 40 bed adult unit, 12 bed adolescent unit
  • 12 years of clinic experience (1988-2000)
  • Pharmacist Specialist at Kaiser Mental Health
    Center in Los Angeles, CA
  • 60 bed adult unit, partial hospitalization
    program
  • Consulting Clinical Pharmacist at BHC Alhambra
    Hospital in Rosemead, CA
  • 25 children, 15 adolescents, 40 adults general
    psychiatry
  • Eating Disorders inpatient, partial
    hospitalization unit

3
Psychiatric Hospitalization
  • Relief that treatment is underway in a safe
    place, with trained medical staff
  • Fear regarding an unknown medical team,
    medication changes, limited contact with loved
    one(s)
  • Concern that symptoms are not fully stabilized
    before discharge
  • Unaware that a pharmacist is actively
    participating in care and can be a resource

4
Role of the Pharmacist
  • Multidisciplinary treatment planning
  • Individual medication review, recommendations
  • Appropriate medication, dose, duration of tx
  • Drug intx screening, monitoring, simplify dosing
  • Fill prescriptions for routine and prn
    medications
  • Proper labeling, integrity, security of
    medications
  • Education of patients, treatment team, family
  • Individual counseling, medication group,
    discharge counseling, family meetings, new drug
    inservices

5
Medication Recommendations Another pair of
eyes.
  • Dose too low, Dose too high
  • Adequate trial has not been achieved yet, allow
    more time before change
  • Give at bedtime to minimize daytime sleepiness
    or Give in am to prevent insomnia
  • Check liver, kidney, thyroid, cholesterol,
    glucose, to ensure safety of medication
  • Interpret lithium or valproate blood level

6
Individual Medication Review
  • JJ is a 22 year old hospitalized for running
    naked in the street paranoid, not sleeping, Dx
    Schizoaffective
  • Current medications risperidone 4mg/d,
    olanzapine 30 mg/d, lithium 600mg/d, clonazepam
    2mg
  • Lithium level 0.6 mEq/L
  • Recommendation optimize lithium dose for
    maximum benefit, may not need 2 antipsychotics or
    clonazepam when lithium level is 0.8-1.2mEq/L
  • Use tylenol for pain instead of ibuprofen to
    avoid increase in lithium level and potential for
    toxicity

7
Individual Medication Review
  • FA is a 42 year old hospitalized after stopping
    olanzapine 30mg when told of Hep C, ? liver
    enzymes, ?cholesterol, Dx Schizophrenia,
    substance abuse
  • AH, VH, persecutory delusions, depression,
    isolation
  • Current meds quetiapine 1200mg/d, citalopram
    40mg/d, trazodone 200mg, temazepam 30mg at
    bedtime x 4wk
  • Recommendation taper off quetiapine and start
    loxapine because it has gt D2 blockade, evidence
    of liver safety
  • Psychosis greatly improved, trazodone, temazepam
    tapered off with ? daytime sedation, more
    socialization

8
Individual Med Consultation - SE
  • BB, a 36 yo engineer has response to Abilify
    and Depakote but is concerned that coworkers will
    notice hand tremor or tremor will interfere with
    functioning at work. Discharge in 2 days
  • Recommend propranolol for tremor if related to
    Depakote, benztropine if tremor from Abilify
  • Discuss recommendations with physician, BB

9
Medication Education Group
  • 45 to 60 minutes, 6 12 patients
  • Interactive Discussion structured format
  • Overview of psychotropics thought organizers,
    mood stabilizers, antidepressants, sleep meds
  • Goals de-stigmatize illness and medications,
    discuss med benefits, side effects/management
  • Answer questions and address concerns
  • Discuss consequences of alcohol drugs

10
Medication Education Group
  • 22 yo newly diagnosed bipolar, resistant to meds
    hears from a 52 yo w/ bipolar x 30yrs,
    Medication keeps you out of the hospital.
  • 48 yo, obese person w/ diabetes learns there are
    meds w/ low to no weight gain and receives
    support from others struggling w/ weight issues
  • 36 yo, tells group Taking medication helps keep
    me off drugs and alcohol

11
Discharge Medication Counseling
  • PR is a 27 yo mother of 2 hospitalized after a
    suicide attempt, in hospital x 7 days
  • Diagnosis Major depression w/ psychosis
  • Discharge medications
  • fluoxetine 20mg qam, olanzapine 15mg qhs
  • Question how come I dont feel much better?
  • Concern I dont want to be addicted to drugs
  • Family planning issues

12
Family Meetings
  • Family and friends provide encouragement and
    support to facilitate recovery, prevent relapse
  • How can refills be obtained? how often do blood
    tests need to be done?
  • What can risperidone liquid be mixed with?
  • Is it safe to take an antidepressant with blood
    pressure or pain medication?

13
Clinical Pharmacists Improve Care in Hospitals
  • 36 studies analyzed
  • General Medicine, Geriatrics, Psychiatry
  • Activities interacting with health-care team, pt
    interviews, monitoring, discharge counseling
  • Improved med appropriateness
  • Improved med adherence
  • Decreased med errors
  • Decreased adverse drug events

Kaboli P. Archives of Internal Medicine
2006166955-964
14
Outcomes of Clinical Pharmacist Interventions in
Psychiatric Hospital
  • 93 participants
  • Compared usual care to regular pharmacist
    assessments, recommendations, education
  • Improved clinical response (? psychosis ? mood
    measured on objective rating scales
  • Decreased abnormal involuntary movements
  • Decreased restlessness (akathisia)
  • No sig. difference in med costs or length of stay

Canales PL Am J Health-System Pharmacy
2001581309-1316
15
Recommendations
  • Ask if hospital has a clinical pharmacist
    participating in treatment and med education
  • Ask for medication consultation with a pharmacist
    prior to discharge from hospital
  • Ask about clinic follow-up appointments
  • Verify discharge prescriptions include enough
    medication to last until clinic appointment
  • Utilize medication fact sheets and Ask the
    Psychiatric Pharmacist on NAMI.org
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