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CHAPTER AIMS
The aims of this chapter are to:
Describe acute care pharmacy practice within an interprofessional inpatient psychiatric team.
Discuss the Pharmacists’ Patient Care Process (PPCP), critical thinking, and clinical reasoning in assessing and resolving medication-related problems as part of an interprofessional effort to provide patient-centered care for schizophrenia or mental health.
Illustrate the use of clinical reasoning, critical thinking, and the PPCP to address common medication-related problems, including adherence, encountered in an example case of a patient with schizophrenia and medical comorbidities.
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KEY WORDS
• Nonadherence • clozapine • schizophrenia • critical thinking • clinical reasoning • PPCP
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Acute care pharmacy practice in an inpatient psychiatric unit provides ample opportunities for managing psychopharmacology, acutely decompensated mental health disease states, and comorbid medical conditions. Acute care psychiatry is a practice area where pharmacists can play a vital role in patient assessment, patient safety, treatment plan development, drug–drug interactions, pharmacotherapy and pharmacokinetic monitoring, patient education, and transitions of care.
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KEY POINT
The role of pharmacy on inpatient psychiatry is diverse and includes medication reconciliation, recognizing and managing drug therapy problems, input into pharmacotherapy plans, monitoring adverse effects, pharmacokinetic monitoring, and provider, patient, and caregiver education.
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Patients receiving care in an acute care inpatient psychiatry unit may present with a variety of disease states, and many patients with the same diagnosis can have symptoms that vastly differ from one another, making it critical to individualize care. They often have comorbidities, both psychiatric and nonpsychiatric, that can increase the complexity of diagnosis and treatment. A survey of 334 psychiatric pharmacists found that 41.3% of respondents also treated nonpsychiatric disease states as part of their pharmacist care process.1
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OUR PRACTICE—AN INPATIENT PSYCHIATRIC UNIT WHERE A CLINICAL PHARMACIST IS PART OF AN INTERPROFESSIONAL TEAM
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Our practice is an acute care rotation at an adult inpatient psychiatric unit at an academic medical center with four care teams. Each team primarily focuses on one disorder (Medical Psychiatry, Geriatric Psychiatry, Mood Disorders, and Psychotic Disorders/Schizophrenia). We also have a separate child/adolescent inpatient psychiatry building/unit. This is specific to our hospital and may differ at other psychiatric inpatient units or institutions. Patients are admitted to the unit due to concerns that, as a result of a mental illness, they present a danger to themselves, a danger to others, or cannot meet their basic needs for survival (eg, finding food or shelter). Patients vary in their level of understanding or awareness of their symptoms (referred to as insight). Some patients have never before been diagnosed with a mental illness, while others have a history of multiple admissions with similar presentations. The average length of stay is 5 to 7 days.
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Pharmacy is part of an interprofessional team comprised of an attending psychiatrist, ...