According to the World Health Organization (WHO), medications have had an “unprecedented” positive effect on health, affecting mortality and disease burden and leading to an improved quality of life for patients.1 The WHO describes responsible use of medicines as that involving activities, capabilities, and resources of health system stakeholders that align to guarantee patients receive the correct medications at the correct time, use them properly, and benefit from them.1 Despite this, medications are not always appropriately used and there are missed opportunities when the right medication does not reach the right patient.1 Medications can be
The United States (US) has successful accreditation systems for their healthcare facilities and this perception continues to grow globally. As one would assume, worldwide standards of assessment are not the same as standards for facilities within the US. Joint Commission International (JCI) has a comparable but different set of standards that have been developed to incorporate unique economic, social, and cultural differences. Presently, the JCI standards for international psychiatric facilities are the same as the standards set for international hospitals. Institute of Mental Health, an acute tertiary psychiatric hospital in Singapore, has received JCI hospital accreditation consecutively since 2005. ‘Medication Management and Use’ is an important component of the survey process. Product selection, storage, administration and monitoring of medication effects are complex and require expertise to achieve high levels of patient safety. Certain standards and processes that are implemented, measured and undertaken by the pharmacy department are addressed. The benefits of a JCI accreditation are countless for the organization involved. Considered as the international gold standard for hospitals, successive JCI accreditations illustrate that a healthcare organization is committed to improving safety and quality of patient care by continually striving to reduce risks.
Patients with schizophrenia commonly receive more than one antipsychotic concurrently despite little evidence to support this practice. The Joint Commission has recently implemented Hospital-Based Inpatient Psychiatric Services (HBIPS) quality measures to monitor and reduce inappropriate antipsychotic polypharmacy in patients. Pharmacists need to have a clear understanding of these quality measures and consider their role in improving appropriate antipsychotic use.
Introduction: Recent trials have failed to demonstrate differences in efficacy between first generation antipsychotics (FGAs) and second generation antipsychotics (SGAs). To reduce costs, many health care systems have restricted the availability of SGAs through use of prior authorizations. Restrictions for the off-label use of SGAs and the use of dual-antipsychotic therapy have also been implemented in many health care systems. At the South Texas Veterans Health Care System (STVHCS), a restricted drug request (RDR) method has been implemented to manage costs and improve patient safety. Risperidone, due to its lower cost and equal efficacy, is the first-line option of SGAs. If one wishes to prescribe an SGA other than risperidone, an RDR is submitted and reviewed by Veterans Integrated Service Network (VISN) pharmacists. Since the introduction of these policies at the STVHCS, the impact of the RDR has not been assessed.
Rationale: The primary aim of this study was to determine the effects of the RDR policy on the care of STVHCS veterans as evidenced by changes in hospitalization rates of veterans with a denied request for an SGA due to initial criterion failure. Secondary outcomes included: impact of antipsychotic RDR denial on mental health as evidenced by changes in no-shows and cancellations for follow-up psychiatric appointments, psychiatric emergency department visits, presence of suicidal ideation, change in weight, hemoglobin A1c, number of psychotropic medications prescribed, and extrapyramidal symptoms.
Methods: A retrospective chart review of veterans denied an initial SGA request was conducted from 3 months prior to denial to 3 months post request denial (index date). Data collected included: patient demographics, indication for SGA request, reason for SGA denial, length of time for request evaluation, number of psychiatric hospitalizations, number of no-shows and cancellations for mental health appointments, number of psychiatric emergency department visits, number of reports of suicidal ideation or attempts, weight, hemoglobin A1c lab results, presence of extrapyramidal symptoms, and number of prescribed psychotropic medications. The health care utilization data collected pre- and post-index date, were compared. Results were analyzed using Fisher's Exact, 2-tailed standardized t-tests, and descriptive statistics appropriately matched to data type.
Results: Results for both primary and secondary outcomes were not statistically significant. No differences were found in the number of veterans hospitalized pre- versus post-index date [0/33 (0%) versus 2/33 (6%), p=0.492.] The most requested indication for an SGA was PTSD [22/33 (66.7%)] and the most frequently denied SGA was quetiapine [16/33 (48.5%)].
Conclusions: Although outcomes were not statistically significant, several valuable conclusions were drawn from this research. Positive outcomes from a RDR policy were seen by the limitations placed on inappropriate medication prescribing. Also, it was observed that the number of approvals for SGAs was almost three times higher than denials. A subsequent finding from this research is the apparent lack of metabolic monitoring for veterans prescribed SGAs. Further research on these observations, as well as conducting a pharmacoeconomic analysis on the RDR policy, would also be beneficial information for health care providers.
The utilization of opioid medications in the treatment of pain and the associated potential for diversion and misuse of these medications has risen 160% in our country in the last 10 years. In North Carolina, this is reflected in the deaths of 11.4 persons per 100,000 citizens annually, ranking the state as the 22nd in the country in deaths by unintentional poisonings. The majority of these deaths were linked to prescription opioids, with a significant decrease in the last decade in deaths related to heroin and cocaine. The Centers for Disease Control and White House's Office of National
Transitions of care during a hospitalization, including admission, transfers between units, and discharge are critical processes for medication safety and areas where pharmacy can contribute. Medication discrepancies have a significant impact on patient outcomes and both The Joint Commission (TJC) and the American Society of Health-System Pharmacists (ASHP) have recognized the importance of medication reconciliation in preventing these discrepancies. In 2005, The Joint Commission made medication reconciliation a component of one of its Hospital National Patient Safety Goals (NPSG.08.01.01).1 Implementation challenges resulted in its suspension in 2009 and 2010 for revision.1 A modified goal was released
Seriously mentally ill patients are known to have rates of mortality much greater than those of the general population. Prior research in Texas has shown inpatient Public Mental Health Clients (PMHCs) treated in in-patient settings were subject to greatly increased mortality, but little is known about the mortality of PMHCs in an outpatient setting in Texas. For this study outpatient service records for PMHCs treated in Texas were combined with death data from the Texas Department of State Health Services for 2006–2008. Frequencies of causes of death, age-adjusted death rates, standardized mortality ratios, and life expectancies were calculated from these data. The most frequent causes of death were external causes, followed by circulatory disease, and then neoplasms. Examination of the outcomes suggests that substance abuse plays a major role in the mortality of PMHCs in Texas in the form of drug overdoses, tobacco-related cancers, and alcoholic liver disease. Prevention efforts should therefore aim at integrating mental health services, substance abuse services, and careful medical and pharmacological monitoring, including medication monitoring to prevent suicides and accidental overdoses.
Antwone's story has several motifs that can be seen in the lives of many of our patients who are dealing with the likes of Post-Traumatic Stress Disorder. Without the tools to adequately work through his pain, Antwone turned to rage as his outlet during stressful situations. Rage may be replaced with other symptoms like substance abuse, inappropriate risk taking, or poor relationships in our patients' personal stories, but the solution we can offer is similar to the one Davenport provides. As a mental health provider we offer a human connection, support, and hope. By building a relationship ofSTUDENT PERSPECTIVE
CPNP members maintain a suggested reading list to provide information on peer recommended resources and convenient access to the highest quality neuropsychopharmacology publications. A reminder that if you shop with CPNP, by following the links below to Amazon, a small commission will be paid to CPNP which helps to financially support our mission to improve the minds and lives of individuals with psychiatric and/or neurologic disorders. You can help grow this list of resources by suggesting a book. Book: Movies and Mental Illness: Using Films to Understand Psychopathology The popular and criticallyFROM THE PUBLISHER
As a clinical faculty, it's only fitting that my term as CPNP president officially starts on July 1st, “Summertime”, the time for transition of residents in hospitals and clinics. It's a high energy time with longer days and sometimes “heated” therapeutic debates or discussions on policies and procedures. It is no different for CPNP, summertime is our season for planning, brainstorming and renewal. Committees are setting a course for productivity and CPNP leadership is immersed in strategic planning. Strategic planning work groups are meeting to brainstorm ideas on how to increase membership value, improve member communication, realize synergy
July 1 is the start of CPNP's fiscal year and the transition of officers on the Board of Directors. Meet your 2013–2014 officers. Dr. Dopheide received a Doctor of Pharmacy Degree from the UniversityGET TO KNOW YOUR BOARD OF DIRECTORS FOR 2013–2014
President