Implementation of a Pharmacy-Led Psychotropic Stewardship Pilot Program at an Academic Medical Center

Abstract

Background

Psychotropic stewardship programs (PSPs) have been proposed to optimize psychiatric medication use and improve medication safety; however, data describing their implementation and impact in general medical inpatient settings remain limited. This quality improvement project evaluated a pharmacist-led PSP pilot at an academic medical center.

Methods

Adult inpatients were identified using predefined criteria including use of high-risk psychotropic agents (carbamazepine, clozapine, lithium, lamotrigine, valproic acid [VPA]), scheduled benzodiazepines in patients 65 years and older, and psychotropic polypharmacy (≥ 3 antidepressants or ≥ 2 antipsychotics). Pharmacists and prescribers could also identify patients for review. Exclusion criteria included admission to inpatient behavioral health units, active psychiatry consultation, admission to the acute palliative care/hospice unit, and emergency department status. Over 1 month, a pharmacist conducted chart reviews and collaborated with a psychiatrist to provide recommendations to primary teams. Interventions and outcomes were tracked and summarized using descriptive statistics.

Results

During the pilot period, 626 patients were flagged for review; 473 met inclusion criteria and 190 underwent full evaluation. A total of 176 psychotropic stewardship interventions were recommended, of which 162 were accepted (92%). Patients were most identified by direct prescriber- or pharmacist-initiated review (51.1%) and high-risk psychotropic use (30.1%). Medication reconciliation (29.0%) accounted for the largest proportion of interventions made, followed by dose optimization (26.1%) and medication discontinuation (13.6%). Selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) were the most frequently involved medication classes (23.9%).

Conclusion

A pharmacist-led PSP was feasible in a general medical inpatient setting and resulted in a high rate of accepted interventions. These findings support the role of pharmacists in improving psychotropic medication safety and highlight opportunities for targeted, system-level interventions. Future work should evaluate clinical outcomes and long-term sustainability of PSPs.