Psychotropic stewardship: Advancing patient care

Abstract

Board Certified Psychiatric Pharmacists (BCPPs) practice in a variety of inpatient and outpatient health care settings as part of collaborative, multidisciplinary teams. The American Association of Psychiatric Pharmacists (AAPP) has promoted the expansion of psychiatric pharmacy through the development of psychotropic stewardship programs (PSPs). Based on the standards developed during the creation and expansion of antimicrobial stewardship programs, psychotropic stewardship promotes the safe and appropriate use of psychotropic medications. AAPP envisions every patient with a psychiatric diagnosis will have their medication treatment plan reviewed, optimized, and managed by a psychotropic stewardship team with a psychiatric pharmacist as a co-leader. Because of variations in practice site resources, patient populations, and provider collaboration, the creation and implementation of PSPs should be based on site-specific needs and opportunities. Initial patient identification could prioritize those prescribed multiple medications, high-risk psychotropics, or comorbid medical diagnoses. However, every patient prescribed a psychotropic medication should have the opportunity to work with a PSP. Incremental implementation may be required during the planning stages of stewardship teams. Use of clinical practice-related core outcomes will allow for the optimization of program resources, increased recognition, and improved patient outcomes. PSPs should be patient-focused and integrate patients' preferences and access to recommended treatment options. The eventual goal of PSP implementation is official recognition by key regulatory agencies as a standard of care for patients who receive a diagnosis of a psychiatric or substance use disorder.

Role of Board‐Certified Psychiatric Pharmacists in child and adolescent psychiatry

“…For example, psychotropic stewardship is a model in which BCPPs play a key medication management role on the interdisciplinary CAP team (Figure 1). 1 Board-Certified Psychiatric Pharmacists work in a variety of unique pediatric settings, including children's hospital psychiatric pavilions, ambulatory clinics, and psychiatric hospitals, and work with diverse CAP patient populations (Table 1). 8,10,[12][13][14][15]17,18,[20][21][22][23][24][25][26][27][28][29][30][31] Where properly integrated, BCPPs are viewed as valuable members of the CAP team by CAP, pediatricians, and foster care social workers, among others.…”

“…34 Regulatory standards, including the Hospital Based Inpatient Psychiatric Services measure set, a collection of quality measures created by The Joint Commission, aims to standardize the quality of care patients receive in psychiatric care settings. 1,35 Board-Certified Psychiatric Pharmacists in CAP are well positioned to support these quality care initiatives given their roles in medication monitoring, deprescribing practices, medication safety, medication reconciliation, and psychotropic stewardship (Table 2). 1,4…”

“…1,35 Board-Certified Psychiatric Pharmacists in CAP are well positioned to support these quality care initiatives given their roles in medication monitoring, deprescribing practices, medication safety, medication reconciliation, and psychotropic stewardship (Table 2). 1,4…”

“…Youth in Foster Care 12,13,15 • Higher rates of antipsychotic prescribing, supratherapeutic dosing, and off-label use Through the implementation of psychotropic stewardship, BCPPs have an opportunity to optimize these PQMP standards. 1 When pharmacists are involved in decision-making regarding prescribing antipsychotics, the rates of antipsychotic polypharmacy decrease in both inpatient and outpatient levels of care. 37 According to the National Committee for Quality Assurance (NCQA), in 2018, of youth prescribed an antipsychotic, 2.6% (Commercial Health Maintenance Organization [HMO]), 2.7% (Commercial [Preferred Provider Organization {PPO}]), and 2.4% (Medicaid HMO) were prescribed ≥2 concurrent antipsychotics for ≥3 months.…”

“…Board-Certified Psychiatric Pharmacists are members of the interdisciplinary team who work collaboratively with patients, their families, and providers to optimize short-and long-term outcomes among individuals with psychiatric disorders, including substance use disorders (SUDs). [1][2][3] They are educators and advocates for the evidence-based use of psychotropic medications through comprehensive medication management (CMM). In addition to unique settings and roles, BCPPs work with a variety of patient populations, including children and adolescents.…”