薬剤師の介入による向精神薬適正使用と転倒・転落事故数への影響

Abstract

Fall accidents, in which psychotropic polypharmacy is sometimes involved, are serious in medical safety management. We, clinical pharmacists, started to participate in the multi-disciplinary care team for inpatients at the psychiatric unit in Kyoto University Hospital in April 2012. After the patient interview on admission day, we propose a suitable prescription for the proper use of psychotropic drugs. In this study, we investigated the impacts of clinical pharmacy interventions aiming to reduce the psychotropic polypharmacy by evaluating fall accidents during hospitalization. We calculated the dosages of hypnotics, anxiolytics, antipsychotics, antidepressants and antiparkinson agents prescribed at the psychiatry unit in Kyoto University Hospital, as corresponding values, which were diazepam, chlorpromazine, imipramine and biperiden equivalents, respectively, from the computerized electronic records for the period 2011 - 2014. We found a significant reduction in the dosages of long and short-acting hypnotics, anxiolytics, typical antipsychotics (but not atypical antipsychotics) and antiparkinsonian drugs after the introduction of the pharmacist intervention. In contrast, there was a trend toward increased dosages of antidepressants. The numbers of concomitant drugs of each of hypnotics and antipsychotics were decreased significantly. Furthermore, the number of fall accidents reported in the incident reports was decreased to 43-45 from 55 accidents/year after the intervention. These results suggest that clinical pharmacist intervention could contribute to the reduction of the doses used and prevention of polypharmacy in psychotropic drug use, and might be associated with the decrease in the number of fall accidents.