Pharmacist intelligent referrals to a Psychiatric Liaison Team

Julie Brooks, Aston University

Antipsychotic medications are associated with an increased risk of falls, delirium, cerebrovascular events and all can cause death. It is crucial that patients prescribed these agents receive regular specialist review to optimise therapy and prevent harm. This is achieved at City Hospital with the Rapid Assessment Interface and Discharge (RAID) team. Traditionally, patients were seen by RAID following a referral from medical or nursing staff, however when prescribing was analysed it was found that only a third of patients on these agents were referred. There was therefore the potential to establish if pharmacy could help improve patient’s access to RAID. This was an alternative to the traditional model of pharmacy, with the hope to target clinical services according to patient need rather than by physical ward location. A novel pharmacist referral system was developed using real-time dispensing information to identify hospital in-patients receiving antipsychotics, mood stabilisers or dementia medicines.

A total of 345 patients were reviewed by a pharmacist, 152 (44%) were referred representing an 11% increase from baseline. Nearly half (n=69, 20%) of the referrals were generated by a pharmacist who was also found to have a clinical impact on patient care in an additional 91 (26%) patients. Pharmacy referrals focussed on medication safety, this was different than those generated by medical and nursing staff whose emphasis was on symptoms and behaviour.

The pharmacy referral service was found to enhance the clinical management of the vunerable mental health patient in the hospital setting. Although, the model was demonstrated in mental health, it is felt that it could have a wider use according to the prescription of any high-risk medication. Access to, and transition of information between care sectors was found to be a significant problem and improvements are recommended

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