Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility
Introduction The Psychotropic Drug Safety Initiative (PDSI) is a national Veterans Affairs program that recommends obtaining cardiovascular vital signs semiannually and urine toxicology screening annually for veterans prescribed stimulants. The PDSI also recommends a risk review of concurrent centra...
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| Format: | Article |
| Language: | English |
| Published: |
American Association of Psychiatric Pharmacists
2024-02-01
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| Series: | Mental Health Clinician |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.9740/mhc.2024.02.017 |
| _version_ | 1797323970558558208 |
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| author | Bailey B. Bass, PharmD, BCPS Lacey J. Vann, PharmD, BCPP |
| author_facet | Bailey B. Bass, PharmD, BCPS Lacey J. Vann, PharmD, BCPP |
| author_sort | Bailey B. Bass, PharmD, BCPS |
| collection | DOAJ |
| description | Introduction
The Psychotropic Drug Safety Initiative (PDSI) is a national Veterans Affairs program that recommends obtaining cardiovascular vital signs semiannually and urine toxicology screening annually for veterans prescribed stimulants. The PDSI also recommends a risk review of concurrent central nervous system (CNS) depressants to ensure the benefits of coadministration with stimulants outweigh the risks. This project’s purpose was to evaluate the occurrence of coprescriptions for CNS depressants and stimulants and encourage compliance with the PDSI recommendations to increase safe and appropriate management of veterans prescribed the combination. This study aimed to evaluate the occurrence of coprescriptions for CNS depressants and stimulants, evaluate compliance with stimulant monitoring recommendations, and measure the proportion of pharmacist recommendations implemented by the prescriber.
Methods
This quality improvement project identified veterans with an outpatient prescription for a stimulant and any coprescription(s) for benzodiazepines, sedative-hypnotics, and/or opioids. A pharmacy intervention note was generated to request a risk review, provide recommendations for de-escalation, and notify the stimulant prescriber of overdue monitoring parameters. Impact was measured 60 days after intervention. Descriptive statistics and a McNemar test were used to compare preintervention and postintervention data.
Results
From the 61 patients included, there were 67 unique prescriptions for benzodiazepines (49.3%), sedative-hypnotics (34.3%), and opioids (16.4%) in combination with a stimulant. Pharmacist intervention resulted in de-escalation of coprescribing for 9 patients (16.1%) and was associated with statistically significant improvement in compliance to stimulant monitoring recommendations.
Discussion
Clinical pharmacists can assist in ensuring safe and appropriate monitoring and management of veterans prescribed stimulants. |
| first_indexed | 2024-03-08T05:36:39Z |
| format | Article |
| id | doaj.art-38acf962d58247a6a6b88124facc314e |
| institution | Directory Open Access Journal |
| issn | 2168-9709 |
| language | English |
| last_indexed | 2024-03-08T05:36:39Z |
| publishDate | 2024-02-01 |
| publisher | American Association of Psychiatric Pharmacists |
| record_format | Article |
| series | Mental Health Clinician |
| spelling | doaj.art-38acf962d58247a6a6b88124facc314e2024-02-05T16:53:33ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092024-02-01141172210.9740/mhc.2024.02.017i2168-9709-14-1-17Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facilityBailey B. Bass, PharmD, BCPS0https://orcid.org/0000-0003-3409-3850Lacey J. Vann, PharmD, BCPP1https://orcid.org/0000-0002-4968-65471 PGY-2 Psychiatric Pharmacy Resident, Pharmacy Department, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina2 Mental Health Clinical Pharmacist Practitioner, Mental Health Department, Ralph H. Johnson Veterans Affairs Medical Center, Savannah, GeorgiaIntroduction The Psychotropic Drug Safety Initiative (PDSI) is a national Veterans Affairs program that recommends obtaining cardiovascular vital signs semiannually and urine toxicology screening annually for veterans prescribed stimulants. The PDSI also recommends a risk review of concurrent central nervous system (CNS) depressants to ensure the benefits of coadministration with stimulants outweigh the risks. This project’s purpose was to evaluate the occurrence of coprescriptions for CNS depressants and stimulants and encourage compliance with the PDSI recommendations to increase safe and appropriate management of veterans prescribed the combination. This study aimed to evaluate the occurrence of coprescriptions for CNS depressants and stimulants, evaluate compliance with stimulant monitoring recommendations, and measure the proportion of pharmacist recommendations implemented by the prescriber. Methods This quality improvement project identified veterans with an outpatient prescription for a stimulant and any coprescription(s) for benzodiazepines, sedative-hypnotics, and/or opioids. A pharmacy intervention note was generated to request a risk review, provide recommendations for de-escalation, and notify the stimulant prescriber of overdue monitoring parameters. Impact was measured 60 days after intervention. Descriptive statistics and a McNemar test were used to compare preintervention and postintervention data. Results From the 61 patients included, there were 67 unique prescriptions for benzodiazepines (49.3%), sedative-hypnotics (34.3%), and opioids (16.4%) in combination with a stimulant. Pharmacist intervention resulted in de-escalation of coprescribing for 9 patients (16.1%) and was associated with statistically significant improvement in compliance to stimulant monitoring recommendations. Discussion Clinical pharmacists can assist in ensuring safe and appropriate monitoring and management of veterans prescribed stimulants.https://theijpt.org/doi/pdf/10.9740/mhc.2024.02.017stimulantdrug interactionmonitoringsafetypharmacist |
| spellingShingle | Bailey B. Bass, PharmD, BCPS Lacey J. Vann, PharmD, BCPP Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility Mental Health Clinician stimulant drug interaction monitoring safety pharmacist |
| title | Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility |
| title_full | Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility |
| title_fullStr | Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility |
| title_full_unstemmed | Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility |
| title_short | Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility |
| title_sort | clinical pharmacist intervention to ensure safe stimulant prescribing practices at a veterans affairs facility |
| topic | stimulant drug interaction monitoring safety pharmacist |
| url | https://theijpt.org/doi/pdf/10.9740/mhc.2024.02.017 |
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