International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 1077–1086 | Cite as

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

  • Tom E. RichardsonEmail author
  • Claire L. O’Reilly
  • Timothy F. Chen
Research Article


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.


Australia Clinical pharmacy Drug-related problems Mental health Pharmaceutical services Qualitative research 



The Authors would like to acknowledge the Society of Hospital Pharmacists Australia (SHPA) and Christine Culhane the chair of the Mental Health Committee of Specialty Practice for all their support throughout this project.


No funding was received to conduct this research.

Conflicts of interest

The authors report no conflict of interest.

Supplementary material

11096_2014_9997_MOESM1_ESM.doc (44 kb)
Supplementary material 1 (DOC 44 kb)


  1. 1.
    Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: The National Academies Press; 2000.Google Scholar
  2. 2.
    Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42(7–8):1017–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Miguel A, Azevedo LF, Araujo M, Pereira AC. Frequency of adverse drug reactions in hospitalized patients: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2012;21(11):1139–54.PubMedCrossRefGoogle Scholar
  4. 4.
    de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17(3):216–23.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277(4):307–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33(6):766–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013;346:f2539.Google Scholar
  8. 8.
    Grohmann R, Hippius H, Helmchen H, Ruther E, Schmidt LG. The AMUP study for drug surveillance in psychiatry: a summary of inpatient data. Pharmacopsychiatry. 2004;37(1):S16–26.PubMedGoogle Scholar
  9. 9.
    Degner D, Grohmann R, Kropp S, Rüther E, Bender S, Engel RR, et al. Severe adverse drug reactions of antidepressants: results of the German Multicenter Drug Surveillance Program AMSP. Pharmacopsychiatry. 2004;37(1):39–45.Google Scholar
  10. 10.
    Leape LL, Cullen DJ, Clapp M, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282(3):267–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med. 2003;163(17):2014–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Dooley MJ, Allen KM, Doecke CJ, Galbraith KJ, Taylor GR, Bright J, et al. A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. Br J Clin Pharmacol. 2004;57(4):513–21.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Pickard AS, Hung S-Y. An update on evidence of clinical pharmacy services’ impact on health-related quality of life. Ann Pharmacother. 2006;40(9):1623–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Altowaijri A, Phillips CJ, Fitzsimmons D. A systematic review of the clinical and economic effectiveness of clinical pharmacist intervention in secondary prevention of cardiovascular disease. J Manag Care Pharm. 2013;19(5):408–16.PubMedGoogle Scholar
  16. 16.
    Richardson TE, O’Reilly CL, Chen TF. A comprehensive review of the impact of clinical pharmacy services on patient outcomes in mental health. Int J Clin Pharm. 2014;36(2):222–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Brown S, Barraclough B, Inskip H. Causes of the excess mortality of schizophrenia. Br J Psychiatry. 2000;177(3):212–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). The Lancet. 2009;374(9690):620–7.CrossRefGoogle Scholar
  19. 19.
    Stoner SC, Ott CA, Dipaula BA. Psychiatric pharmacy residency training. Am J Pharm Educ. 2010;74(9):163.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    College of Mental Health Pharmacy. Credentialing—Full CMHP Membership (MCMHP). 2013. Accessed on 2013 November 1.
  21. 21.
    SHPA Committee of Specialty Practice in Mental Health Pharmacy. Standards of practice for mental health pharmacy. J Pharm Pract Res. 2012;42(2):142–5.Google Scholar
  22. 22.
    Doessel DP, Scheurer RW, Chant DC, Whiteford HA. Australia’s national mental health strategy and deinstitutionalization: some empirical results. Aust N Z J Psychiatry. 2005;39(11–12):989–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Department of Health and Ageing. National mental health report 2010: summary of 15 years of reform in Australia’s mental health services under the National Mental Health Strategy 1993–2008. Canberra: Commonwealth of Australia; 2010.Google Scholar
  24. 24.
    Alderman CP. A prospective analysis of clinical pharmacy interventions on an acute psychiatric inpatient unit. J Clin Pharm Ther. 1997;22(1):27–31.PubMedCrossRefGoogle Scholar
  25. 25.
    NSW Health. Severity Assessment Code (SAC) Matrix. Sydney: New South Wales Government; 2005. Accessed 2013 October 24.
  26. 26.
    Society of Hospital Pharmacists Australia. Directory of Hospital Pharmacy. Melbourne; 2011.Google Scholar
  27. 27.
    SHPA Committee of Specialty Practice in Clinical Pharmacy. Standards of practice for clinical pharmacy services. J Pharm Pract Res. 2013;43(2)(suppl):44.Google Scholar
  28. 28.
    Virani A, Crown N. The impact of a clinical pharmacist on patient and economic outcomes in a child and adolescent mental health unit. Can J Hosp Pharm. 2003;56(3):158–62.Google Scholar
  29. 29.
    Marino J, Caballero J, Llosent M, Hinkes R. Differences in pharmacy interventions at a psychiatric hospital: comparison of staff pharmacists, pharmacy faculty, and student pharmacists. Hosp Pharm. 2010;45(4):314–9.CrossRefGoogle Scholar
  30. 30.
    Campbell AR, Nelson LA, Elliott E, Hieber R, Sommi RW. Analysis of cost avoidance from pharmacy students’ clinical interventions at a psychiatric hospital. Am J Pharm Educ. 2011;75(1):8.Google Scholar
  31. 31.
    Stoner SC, Worrel JA, Jones MT, Farrar CA, Ramlatchman LV. Pharmacist-designed and -implemented pharmaceutical care plan for antipsychotic-induced movement disorders. Pharmacotherapy. 2000;20(5):583–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Dorevitch A, Perl E. The impact of clinical pharmacy intervention in a psychiatric inpatient hospital. J Clin Pharm Ther. 1996;21:45–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Suehs BT, Mican LM, Campbell AH. Retrospective evaluation of an inpatient psychiatric pharmacist consultation service. J Am Pharm Assoc (2003). 2011;51(5):599–604.Google Scholar
  34. 34.
    Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010;3(3):CD005470.Google Scholar
  35. 35.
    Makowsky MJ, Schindel TJ, Rosenthal M, Campbell K, Tsuyuki RT, Madill HM. Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. J Interprof Care. 2009;23(2):169–84.PubMedCrossRefGoogle Scholar
  36. 36.
    Australian Institute of Health and Welfare. Medical workforce 2011. National Health Workforce series no. 3. Canberra; 2013.Google Scholar
  37. 37.
    Stratford J. How does Australia train its psychiatrists? Psychiatr Bull. 2002;26(2):73–4.CrossRefGoogle Scholar
  38. 38.
    De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011;10(2):138–51.PubMedGoogle Scholar
  39. 39.
    Millar H. Management of physical health in schizophrenia: a stepping stone to treatment success. Eur Neuropsychopharmacol. 2008;18(2):121–8.CrossRefGoogle Scholar
  40. 40.
    Parks J, Svendsen D, Singer P, Foti ME, Mauer B. Morbidity and mortality in people with serious mental illness: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council Alexandria, VA; 2006.Google Scholar
  41. 41.
    Hetrick SE, Simmons M, Thompson A, Parker AG. What are specialist mental health clinician attitudes to guideline recommendations for the treatment of depression in young people? Aust N Z J Psychiatry. 2011;45(11):993–1001.PubMedCrossRefGoogle Scholar
  42. 42.
    Lehman AF, Steinwachs DM, Project TSC-IotP. Patterns of usual care for schizophrenia: initial results from the schizophrenia patient outcomes research team (PORT) client survey. Schizophr Bull. 1998;24(1):11–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):1–72.Google Scholar
  44. 44.
    Advanced Practice Framework Steering Committee. An advanced pharmacy practice framework for Australia—October 2012. Canberra; 2012.Google Scholar
  45. 45.
    Williams M, Peterson G, Tenni P, Bindoff I, Stafford A. DOCUMENT: a system for classifying drug-related problems in community pharmacy. Int J Clin Pharm. 2012;34(1):43–52.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Tom E. Richardson
    • 1
    Email author
  • Claire L. O’Reilly
    • 1
  • Timothy F. Chen
    • 1
  1. 1.Faculty of PharmacyThe University of SydneySydneyAustralia

Personalised recommendations