Nicole Ganzer, Brandon Utter, B. DeJongh, M. Behrens, Guadalupe Garcia, Rebecca L. Graham
Introduction: Second-generation antipsychotics (SGA) are often prescribed prior to first-generation antipsychotics (FGA) for mental health disorders by reason of proposed improved tolerability. Patients on SGA are not always appropriately screened for metabolic parameters in the clinical setting. A metabolic clinic was previously established for a limited time period at the West Palm Beach Veterans Affairs Medical Center (WPB VAMC) with beneficial outcomes. Re-implementation expanded the clinic to assess the impact when patients were referred from outpatient mental health and primary care providers. The objectives of this quality improvement initiative were to evaluate pharmacologic and nonpharmacologic interventions and compare the patient load preexpansion and postexpansion of the metabolic clinic. Methods: Patients receiving SGA at the WPB VAMC who met the criteria for metabolic syndrome were referred to the metabolic clinic. Preclinic data variables collected include demographics, social history, SGA,...
{"title":"Re-implementation of a pharmacist-managed metabolic syndrome clinic in an outpatient mental health clinic setting","authors":"Nicole Ganzer, Brandon Utter, B. DeJongh, M. Behrens, Guadalupe Garcia, Rebecca L. Graham","doi":"10.9740/MHC.2015.01.057","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.057","url":null,"abstract":"Introduction: Second-generation antipsychotics (SGA) are often prescribed prior to first-generation antipsychotics (FGA) for mental health disorders by reason of proposed improved tolerability. Patients on SGA are not always appropriately screened for metabolic parameters in the clinical setting. A metabolic clinic was previously established for a limited time period at the West Palm Beach Veterans Affairs Medical Center (WPB VAMC) with beneficial outcomes. Re-implementation expanded the clinic to assess the impact when patients were referred from outpatient mental health and primary care providers. The objectives of this quality improvement initiative were to evaluate pharmacologic and nonpharmacologic interventions and compare the patient load preexpansion and postexpansion of the metabolic clinic. Methods: Patients receiving SGA at the WPB VAMC who met the criteria for metabolic syndrome were referred to the metabolic clinic. Preclinic data variables collected include demographics, social history, SGA,...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"177 1","pages":"57-62"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86076973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Integrated, patient-centered clinical pharmacy services have been shown to improve patient outcomes in a variety of settings, including mental health. In this article, we describe and report the impact of a restructured clinical practice model that incorporated direct patient care by pharmacists implemented at a psychiatric facility in Edmonton, Canada. The purpose of redesigning the clinical pharmacy program was to deliver proactive pharmacist care through integrated clinical pharmacy services and to better align pharmacists' activities with those that have been reported to have a positive impact on patient outcomes. Methods: Pharmacists' documentation notes in medical records for patients admitted and discharged from the hospital at four different time periods were reviewed. For each time period, the number, type, and documentation rate were measured and compared using a Student t test with correction for unequal variances. Significant change was defined as P < .05. Documentation rates wer...
{"title":"Redesigning the clinical pharmacy practice model at a psychiatric hospital","authors":"M. Zolezzi, I. Gottstein, B. Nilsson","doi":"10.9740/MHC.2015.01.050","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.050","url":null,"abstract":"Introduction: Integrated, patient-centered clinical pharmacy services have been shown to improve patient outcomes in a variety of settings, including mental health. In this article, we describe and report the impact of a restructured clinical practice model that incorporated direct patient care by pharmacists implemented at a psychiatric facility in Edmonton, Canada. The purpose of redesigning the clinical pharmacy program was to deliver proactive pharmacist care through integrated clinical pharmacy services and to better align pharmacists' activities with those that have been reported to have a positive impact on patient outcomes. Methods: Pharmacists' documentation notes in medical records for patients admitted and discharged from the hospital at four different time periods were reviewed. For each time period, the number, type, and documentation rate were measured and compared using a Student t test with correction for unequal variances. Significant change was defined as P < .05. Documentation rates wer...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"72 1","pages":"50-56"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87844445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Take-home naloxone is an important intervention for addressing opioid overdoses. Patients with a history of a substance use disorder are at an elevated risk of experiencing an overdose, and even in...
{"title":"Naloxone prescribing by psychiatric clinical pharmacists for patients receiving opioid agonist treatment","authors":"M. Geier, James J. Gasper","doi":"10.9740/MHC.2015.01.046","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.046","url":null,"abstract":"Take-home naloxone is an important intervention for addressing opioid overdoses. Patients with a history of a substance use disorder are at an elevated risk of experiencing an overdose, and even in...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"64 1","pages":"46-49"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73760652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lisa W Goldstone, B. DiPaula, J. Caballero, Susie H Park, Cristofer Price, M. Slater
Psychiatric pharmacists have specialized knowledge, skills, and training or substantial experience working with patients with psychiatric or neurologic disorders. As part of the collaborative team with a physician, psychiatric pharmacists can provide comprehensive medication management (CMM), a direct patient care service, to patients with psychiatric or neurologic disorders. CMM is a standard of care in which all medications for an individual patient are assessed to determine appropriateness, effectiveness, safety, and adherence. Studies have shown that when psychiatric pharmacists are included as part of the collaborative team with a physician, medication-related outcomes for patients with psychiatric or neurologic disorders improve. Despite the evidence supporting the value of psychiatric pharmacists as part of the health care team, the very limited mechanisms for compensation for CMM limit the numbers of patients with psychiatric or neurologic disorders who have access to services provided by a psychi...
{"title":"Improving medication-related outcomes for patients with psychiatric and neurologic disorders: Value of psychiatric pharmacists as part of the health care team","authors":"Lisa W Goldstone, B. DiPaula, J. Caballero, Susie H Park, Cristofer Price, M. Slater","doi":"10.9740/MHC.2015.01.001","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.001","url":null,"abstract":"Psychiatric pharmacists have specialized knowledge, skills, and training or substantial experience working with patients with psychiatric or neurologic disorders. As part of the collaborative team with a physician, psychiatric pharmacists can provide comprehensive medication management (CMM), a direct patient care service, to patients with psychiatric or neurologic disorders. CMM is a standard of care in which all medications for an individual patient are assessed to determine appropriateness, effectiveness, safety, and adherence. Studies have shown that when psychiatric pharmacists are included as part of the collaborative team with a physician, medication-related outcomes for patients with psychiatric or neurologic disorders improve. Despite the evidence supporting the value of psychiatric pharmacists as part of the health care team, the very limited mechanisms for compensation for CMM limit the numbers of patients with psychiatric or neurologic disorders who have access to services provided by a psychi...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"5 1","pages":"1-28"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79423685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A metropolitan hospital system has developed and implemented a transition-of-care program focusing on patients with mental illnesses and high risk for hospital readmissions or emergency department ...
{"title":"Bridging the gap for patients with mental illness","authors":"Saadia Ali, M. Getz, H. Chung","doi":"10.9740/MHC.2015.01.040","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.040","url":null,"abstract":"A metropolitan hospital system has developed and implemented a transition-of-care program focusing on patients with mental illnesses and high risk for hospital readmissions or emergency department ...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"62 1","pages":"40-45"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79633589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. C. Boswell, Jeff P M Lee, Steven Burghart, Karin Scholtes, Lindsey N. Miller
Introduction: How to improve medication reconciliation has been an ongoing discussion in hospitals across the nation. This study was designed to identify areas for potential improvement in the medication reconciliation process for an 80-bed, inpatient psychiatric hospital. A previous evaluation conducted at the site indicated that 45% of medication reconciliations were correct. Subsequently, a new process was developed to improve this area of patient care. This process included an update to existing medication-reconciliation forms, staff education, and the standardization of all protocols involved. The investigators examined the updated process to identify gaps in patient care during the admission medication-reconciliation process. Methods: The primary outcome of the study was an assessment of the accuracy of the updated medication-reconciliation protocols. Data, including medication, dosage, route, and frequency, were collected from randomly selected patients (13 years and older) admitted during the 2-mo...
{"title":"Medication reconciliation improvement in a private psychiatric inpatient hospital","authors":"J. C. Boswell, Jeff P M Lee, Steven Burghart, Karin Scholtes, Lindsey N. Miller","doi":"10.9740/MHC.2015.01.035","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.035","url":null,"abstract":"Introduction: How to improve medication reconciliation has been an ongoing discussion in hospitals across the nation. This study was designed to identify areas for potential improvement in the medication reconciliation process for an 80-bed, inpatient psychiatric hospital. A previous evaluation conducted at the site indicated that 45% of medication reconciliations were correct. Subsequently, a new process was developed to improve this area of patient care. This process included an update to existing medication-reconciliation forms, staff education, and the standardization of all protocols involved. The investigators examined the updated process to identify gaps in patient care during the admission medication-reconciliation process. Methods: The primary outcome of the study was an assessment of the accuracy of the updated medication-reconciliation protocols. Data, including medication, dosage, route, and frequency, were collected from randomly selected patients (13 years and older) admitted during the 2-mo...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"64 1","pages":"35-39"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83787635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Alzheimer’s disease (AD) and other dementias are associated with symptoms that extend far beyond cognitive deficits. The most distressing of these symptoms are known as the behavioral and psychological symptoms of dementia (BPSD) and include delusions, hallucinations, agitation and aggression, misidentification, and sexually inappropriate behaviors. As a result of BPSD, AD patients suffer a poorer quality of life, as do their caregivers. Behavioral and psychological symptoms can be so distressing to the caregiver that they are a common reason for families placing their loved ones in long-term care. Approximately 60% and 80% of dementia patients living in the community and in long-term care settings develop BPSD, respectively.
{"title":"Management of behavioral and psychological symptoms of dementia: The role of mood stabilizers","authors":"Amber Rayfield, Christopher Thomas, M. Borovicka","doi":"10.9740/MHC.N204493","DOIUrl":"https://doi.org/10.9740/MHC.N204493","url":null,"abstract":"INTRODUCTION Alzheimer’s disease (AD) and other dementias are associated with symptoms that extend far beyond cognitive deficits. The most distressing of these symptoms are known as the behavioral and psychological symptoms of dementia (BPSD) and include delusions, hallucinations, agitation and aggression, misidentification, and sexually inappropriate behaviors. As a result of BPSD, AD patients suffer a poorer quality of life, as do their caregivers. Behavioral and psychological symptoms can be so distressing to the caregiver that they are a common reason for families placing their loved ones in long-term care. Approximately 60% and 80% of dementia patients living in the community and in long-term care settings develop BPSD, respectively.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"8 1","pages":"177-182"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75923747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with mental illness often have co-occurring substance abuse which increases the risk for developing cirrhosis, particularly with common etiologies such as hepatitis and alcoholic liver disease. As such, knowledge of how the disease may impact medication prescribing is important. Unfortunately, there is a paucity of data to guide medication prescribing in these patients. Product labeling information should be used in the clinical decision making process. Additionally, clinicians should consider the etiology of disease, adverse effect profile, and pharmacokinetic parameters including solubility, product formulation, protein binding, hydrophilicity, metabolism, bioavailability, extraction ratios, excretion route, and half-life. Thoughtful consideration should be given when prescribing potentially hepatotoxic medications, and those which may increase bleeding risk in patients with coagulopathy. It is essential to ensure every medication has an appropriate indication and carefully evaluate the need fo...
{"title":"Medication prescribing in liver dysfunction","authors":"Kristen N Gardner, J. Bostwick","doi":"10.9740/MHC.N197913","DOIUrl":"https://doi.org/10.9740/MHC.N197913","url":null,"abstract":"Patients with mental illness often have co-occurring substance abuse which increases the risk for developing cirrhosis, particularly with common etiologies such as hepatitis and alcoholic liver disease. As such, knowledge of how the disease may impact medication prescribing is important. Unfortunately, there is a paucity of data to guide medication prescribing in these patients. Product labeling information should be used in the clinical decision making process. Additionally, clinicians should consider the etiology of disease, adverse effect profile, and pharmacokinetic parameters including solubility, product formulation, protein binding, hydrophilicity, metabolism, bioavailability, extraction ratios, excretion route, and half-life. Thoughtful consideration should be given when prescribing potentially hepatotoxic medications, and those which may increase bleeding risk in patients with coagulopathy. It is essential to ensure every medication has an appropriate indication and carefully evaluate the need fo...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"81 1","pages":"131-137"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84272750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Insomnia is a common sleep disorder which has been shown to adversely affect outcomes in hospitalized patients. This article reviews the available classes of medications that may be considered in the treatment of insomnia in the hospital setting.
{"title":"Insomnia treatment for the medically ill hospitalized patient","authors":"J. Kelly","doi":"10.9740/MHC.N190102","DOIUrl":"https://doi.org/10.9740/MHC.N190102","url":null,"abstract":"Insomnia is a common sleep disorder which has been shown to adversely affect outcomes in hospitalized patients. This article reviews the available classes of medications that may be considered in the treatment of insomnia in the hospital setting.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"3 1","pages":"82-90"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88816697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A holistic approach to patient care in psychiatry","authors":"Tiffany-Jade Kreys","doi":"10.9740/MHC.N198925","DOIUrl":"https://doi.org/10.9740/MHC.N198925","url":null,"abstract":"","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"111 1","pages":"98-99"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79199354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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