Exploring current approaches towards patient prioritisation for clinical pharmacy services in UK mental health inpatient care.

Abstract

Background: Mental health services in the United Kingdom (UK) are experiencing heightened pressures due to an increase in the number of patients accessing secondary mental health services amidst a period of workforce and funding constraints. Patient prioritisation for inpatient clinical pharmacy services is a promising approach to delivering optimal services with limited available resources. Research has identified several patient prioritisation tools used by acute care pharmacists across the UK, yet little is known about the use of pharmaceutical patient prioritisation approaches in mental health settings. Therefore, this study aimed to explore patient prioritisation approaches used by UK inpatient mental health pharmacy teams.

Method: An electronic national questionnaire was distributed among chief/senior pharmacists within all UK mental health organisations to identify the use of patient prioritisation systems (tools or processes). This was followed by semi-structured interviews with representative members from organisations that responded to the questionnaire and reported using prioritisation systems, and document analysis for prioritisation systems if shared. Interviews were transcribed and analysed using thematic analysis as described by Braun & Clarke. Ethical approval was obtained from the University of Manchester Ethics Committee.

Results: A 75.3% (n = 55/73) response rate was achieved for the questionnaire between July 2022 and January 2023. Of organisations that completed the questionnaire, 38.2% (n = 21/55) used a prioritisation system within their inpatient pharmacy services in England (n = 14/21), Scotland (n = 6/21), and Northern Ireland (n = 1/21). Sixteen staff representatives from 15 organisations reporting the use of prioritisation systems were interviewed, and 11 prioritisation documents were received and analysed. Prioritisation systems varied greatly in their complexity and development approaches, and the majority were simplistic in design, developed solely based on existing expertise, and lacked formal evaluation. However, all prioritisation systems were perceived by staff to be beneficial in improving patient safety, standardising care, and optimising clinical pharmacy services. Prioritisation criteria included some high-risk medicines (e.g. lithium), issues related to mental health legislation, and patient related factors such as swallowing difficulties.

Conclusion: This study identified 21 UK-based mental health organisations using systems to prioritise inpatients for clinical pharmacy services. Patient prioritisation systems were reported to be beneficial for pharmacy teams in managing their workload and delivering services despite their reported limitations. However, interviews with a single representative may not fully capture the perspectives and experiences of others.