Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review

Khawagi, Wael Y; Steinke, Douglas; Nguyen, Joanne; Keers, Richard N.

doi:10.1371/journal.pone.0217406

Cited by 11 publications

(24 citation statements)

References 119 publications

(328 reference statements)

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“…50 Our findings found that medication incidents were frequently reported to be associated with the CNS medication class including antipsychotics and antidepressants. Yet, it has been reported that both antipsychotics and antidepressants were among the most commonly identified prescribing safety indicators related to patient with mental health illnesses 51 that could be integrated with informatics tools into everyday clinical practice to identify patients at risk of medication incidents as seen in general hospital and primary care. 52 Whilst the contributory factors identified in this study appear to be similar to those identified in prior error causation studies in general hospital settings such as staff and equipment-related factors, 53,54 some of which were unique to mental health settings.…”

Section: Implications and Recommendations For Improvementmentioning

confidence: 99%

Medication Safety in Mental Health Hospitals: A Mixed-Methods Analysis of Incidents Reported to the National Reporting and Learning System

et al. 2021

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Section: Implications and Recommendations For Improvementmentioning

confidence: 99%

Medication Safety in Mental Health Hospitals: A Mixed-Methods Analysis of Incidents Reported to the National Reporting and Learning System

et al. 2021

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“…Indicators were defined as mental health related if they included (a) mental disorders according to the International Classification of Diseases (ICD‐10) 45 and the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) 46 ; (b) medications that could be used to treat or prevent mental disorder (ie, psychotropics); or (c) medication that can be used to treat or prevent side effects of the psychotropics 33 (eg, anticholinergic medications for the treatment of sialorrhoea and extrapyramidal symptoms caused by antipsychotics) 47 …”

Section: Methodsmentioning

confidence: 99%

Development of prescribing safety indicators related to mental health disorders and medications: Modified e‐Delphi study

Khawagi

Steinke

Nguyen

et al. 2020

Brit J Clinical Pharma

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To develop a set of prescribing safety indicators related to mental health disorders and medications, and to estimate the risk of harm associated with each indicator. Method: A modified two-stage electronic Delphi. The first stage consisted of two rounds in which 31 experts rated their agreement with a set of 101 potential mental health related prescribing safety indicators using a five-point scale and given the opportunity to suggest other indicators. Indicators that achieved 80% agreement were accepted. The second stage comprised a single round in which 29 members estimated the risk of harm for each accepted indicator by assessing the occurrence likelihood and outcome severity using two five-point scales. Indicators were considered high or extreme risk when at least 80% of participants rated each indicator as high or extreme. Results: Seventy-five indicators were accepted in the first stage. Following the second stage, 42 (56%) were considered to be high or extreme risk for patient care. The 42 indicators comprised different types of hazardous prescribing, including drugdisease interactions (n = 12), drug-drug interactions (n = 9), inadequate monitoring (n = 5), inappropriate duration (n = 4), inappropriate dose (n = 4), omissions (n = 4), potentially inappropriate medications (n = 3) and polypharmacy (n = 1). These indicators also covered different mental health related medication classes, including antipsychotics (n = 14), mood stabilisers (n = 8), antidepressants (n = 6), sedative, hypnotics and anxiolytics (n = 6), anticholinergic (n = 6) and nonspecific psychotropics (n = 2). Conclusion: This study has developed the first suite of prescribing safety indicators related to mental health disorders and medications, which could inform the development of future safety improvement initiatives and interventional studies.

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“…Khawagi et al published a systematic review in 2019 identifying potential prescribing safety indicators related to mental health disorders and medications. This review identified 245 potential prescribing safety indicators of which, only 5 related to PPOs in mental illness [ 47 ]. Evidence from UK mental health hospitals indicates a high prevalence of PPOs among people with mental illness [ 48 ].…”

Section: Introductionmentioning

confidence: 99%

The development and validation of a medicines optimisation tool to protect the physical health of people with severe mental illness (OPTIMISE)

Carolan

Keating²,

McWilliams

et al. 2022

BMC Psychiatry

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Background The life expectancy of people with severe mental illness (SMI) is shorter than those without SMI, with multimorbidity and poorer physical health contributing to health inequality. Screening tools could potentially assist the optimisation of medicines to protect the physical health of people with SMI. The aim of our research was to design and validate a medicines optimisation tool (OPTIMISE) to help clinicians to optimise physical health in people with SMI. Methods A review of existing published guidelines, PubMed and Medline was carried out. Literature was examined for medicines optimisation recommendations and also for reference to the management of physical illness in people with mental illness. Potential indicators were grouped according to physiological system. A multidisciplinary team with expertise in mental health and the development of screening tools agreed that 83 indicators should be included in the first draft of OPTIMISE. The Delphi consensus technique was used to develop and validate the contents. A 17-member multidisciplinary panel of experts from the UK and Ireland completed 2 rounds of Delphi consensus, rating their level of agreement to 83 prescribing indicators using a 5-point Likert scale. Indicators were accepted for inclusion in the OPTIMISE tool after achieving a median score of 1 or 2, where 1 indicated strongly agree and 2 indicated agree, and 75th centile value of ≤ 2. Interrater reliability was assessed among 4 clinicians across 20 datasets and the chance corrected level of agreement (kappa) was calculated. The kappa statistic was interpreted as poor if 0.2 or less, fair if 0.21–0.4, moderate if 0.41–0.6, substantial if 0.61–0.8, and good if 0.81–1.0. Results Consensus was achieved after 2 rounds of Delphi for 62 prescribing indicators where 53 indicators were accepted after round 1 and a further 9 indicators were accepted after round 2. Interrater reliability of OPTIMISE between physicians and pharmacists indicated a substantial level of agreement with a kappa statistic of 0.75. Conclusions OPTIMISE is a 62 indicator medicines optimisation tool designed to assist decision making in those treating adults with SMI. It was developed using a Delphi consensus methodology and interrater reliability is substantial. OPTIMISE has the potential to improve medicines optimisation by ensuring preventative medicines are considered when clinically indicated. Further research involving the implementation of OPTIMISE is required to demonstrate its true benefit. Trial registration This article does not report the results of a health care intervention on human participants.

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Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review

Cited by 11 publications

References 119 publications

Medication Safety in Mental Health Hospitals: A Mixed-Methods Analysis of Incidents Reported to the National Reporting and Learning System

Medication Safety in Mental Health Hospitals: A Mixed-Methods Analysis of Incidents Reported to the National Reporting and Learning System

Development of prescribing safety indicators related to mental health disorders and medications: Modified e‐Delphi study

The development and validation of a medicines optimisation tool to protect the physical health of people with severe mental illness (OPTIMISE)

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