Psychiatric patients are at particular risk for adverse clinical events, especially on discharge from hospital. Implementing specific prescribing practices can improve adherence to treatment, reduce the risk of overdose and suicide, and ensure a seamless transition to the next provider of care.
We implemented and published in the literature specific recommendations for safe and effective prescribing practices in three areas of importance in the safe and seamless discharge of psychiatric patients from an inpatient psychiatry unit; treatment adherence, prevention of suicide by overdose and accidental overdose, and communication and accountability.
We applied these recommendations to our discharge practices and updated our discharge checklists (both unit and pharmacy checklists) to ensure completion and accountability of discharge activities.
* Patient’s own medications reviewed and returned when appropriate
* Medications no longer required are disposed in sharps container or sent to pharmacy for destruction
* (Narcotic/Controlled substances)
* Discharge medication calendar provided and reviewed with patient
* Medication changes (medication reconciliation) reviewed with patient
* Rx reviewed with patient
* Rx provided to patient or faxed directly to pharmacy and receipt confirmed
* Rx and medication calendar/reconciliation faxed to health care provider
* This has increased patient satisfaction, and seeming understanding, and has increased understanding and clarified rationale of medication changes for the community pharmacist receiving the new prescription, in optimal position to provide the last phase of medication counseling. It has reduced the number of followup phone calls required by the community pharmacist, thereby avoiding delays in preparing and dispensing medication to the patient.