Drug-related problems and the clinical role of pharmacists in inpatient mental health: an insight into practice in Australia

Background Drug-related problems (DRPs) cause significant morbidity and mortality in healthcare. Clinical pharmacists have shown to reduce DRPs in the inpatient setting. In mental health the effects of clinical pharmacists on DRPs is relatively unknown. Objective To explore the clinical role of inpatient mental health pharmacists and the factors affecting their role. Setting Australian hospitals. Method Mixed methods. As the profile of the hospital mental health pharmacy workforce is unknown, surveys were distributed to all Australian hospitals with a pharmacy department. DRPs and recommendations were classified using an adaptation of the DOCUMENT system. In-depth semi-structured interviews were undertaken with members of the Society of Hospital Pharmacists Australia’s Mental Health Committee of Specialty Practice. Main outcome measures Types of DRPs identified by mental health pharmacists, the recommendations made to address them and the rate at which these recommendations were implemented. As well as mental health pharmacists’ views on the factors which affect their clinical role. Results 277 clinical interventions were reported by 47 mental health pharmacists, with 332 DRPs identified and 355 recommendations made. Drug interactions were the most commonly identified DRP (13.9 %). DRPs ranged in severity and likelihood of occurring. Changes to therapy accounted for the vast majority of recommendations (60.8 %), with the most common being change of drug (29.9 %). In total 91.8 % of recommendations were implemented. On average pharmacists estimated 56.1 % of their clinical interventions focused on psychotropic medication issues. Sixteen pharmacists were interviewed. Their relationship with the medical officers, time constraints and a gap in the evidence base to guide practice were identified as the major factors affecting their role. Conclusion Pharmacists play an important role in ensuring the quality use of medicines in inpatient mental health. However, significant factors need to be addressed to further expand clinical pharmacy services in inpatient mental healthcare in Australia.