Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review.

Wael Y Khawagi,Joanne Nguyen,Richard N Keers,Douglas T Steinke,Mojtaba Vaismoradi

doi:10.1371/journal.pone.0217406

Abstract

BackgroundPrescribing errors and medication related harm may be common in patients with mental illness. However, there has been limited research focusing on the development and application of prescribing safety indicators (PSIs) for this population.ObjectiveIdentify potential PSIs related to mental health (MH) medications and conditions.MethodsSeven electronic databases were searched (from 1990 to February 2019), including the bibliographies of included studies and of relevant review articles. Studies that developed, validated or updated a set of explicit medication-specific indicators or criteria that measured prescribing safety or quality were included, irrespective of whether they contained MH indicators or not. Studies were screened to extract all MH related indicators before two MH clinical pharmacists screened them to select potential PSIs based on established criteria. All indicators were categorised into prescribing problems and medication categories.Results79 unique studies were included, 70 of which contained at least one MH related indicator. No studies were identified that focused on development of PSIs for patients with mental illness. A total of 1386 MH indicators were identified (average 20 (SD = 25.1) per study); 245 of these were considered potential PSIs. Among PSIs the most common prescribing problem was ‘Potentially inappropriate prescribing considering diagnoses or conditions’ (n = 91, 37.1%) and the lowest was ‘omission’ (n = 5, 2.0%). ‘Antidepressant’ was the most common PSI medication category (n = 85, 34.7%).ConclusionThis is the first systematic review to identify a comprehensive list of MH related potential PSIs. This list should undergo further validation and could be used as a foundation for the development of new suites of PSIs applicable to patients with mental illness.

Highlights

Mental disorders are one of the largest contributors toward the global burden of disease, being responsible for 21.2% of years lived with disability (YLDs) [1] and affecting approximately 1 in 5 adults within a given 12 month period and about 1 in 3 at some point in their lives. [2] the quality of care provided to patients with mental illness compared to those with physical health illnesses has been found to be inferior, and their care needs may often remain unmet [3], including the management of comorbid physical conditions [4].Medications are the most frequently used type of treatment for mental disorders [5], yet there are unique challenges when prescribing for this population
There has been limited research focusing on the development and application of prescribing safety indicators (PSIs) for this population
No studies were identified that focused on development of PSIs for patients with mental illness

Summary

Introduction

Medications are the most frequently used type of treatment for mental disorders [5], yet there are unique challenges when prescribing for this population These include the enduring problem of high dose and combination antipsychotic prescribing, use of a number of high risk drugs (e.g. lithium, clozapine), the requirements of mental health law, co-existing substance misuse which may cause interactions with prescribed therapy and a high prevalence of poor lifestyle, multiple comorbidities and polypharmacy which can cause drug–disease and drugdrug interactions [6]. Taking all these factors into account, it may be difficult to achieve balanced prescribing for patients with mental illness [7]. There has been limited research focusing on the development and application of prescribing safety indicators (PSIs) for this population

Methods

Results

Conclusion