Psychiatric Inpatient Settings Research Articles

Practical Guideline on Dealing with Transgender Patients in Child and Adolescent Psychiatric Inpatient Settings

Practical Guideline on Dealing with Transgender Patients in Child and Adolescent Psychiatric Inpatient Settings Abstract: The guideline provided by the Federal Association of Leading Medical Directors for Child and Adolescent Psychiatry offers a framework for dealing with transgender patients in child and adolescent psychiatric clinics. It addresses the clinical challenges arising from the significant increase in transgender patients and the paradigm shift in the medical field. The guideline includes recommendations for dealing with transgender patients in various settings. Key treatment principles comprise adopting a destigmatizing approach, using preferred names and pronouns, accommodating individual room assignments, and considering relevant comorbidities. Only experienced medical doctors and psychotherapists should carry out diagnosis and treatment. The goals for supporting adolescents with gender dysphoria include promoting self-acceptance, addressing negative emotions, facilitating social integration, and fostering identity development.

Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study

BackgroundWorkplace violence is a universal phenomenon faced by employees in all industries but more so by employees working in sectors that require interpersonal contact, especially with individuals who may be violent, distressed, or vulnerable. Globally, healthcare professionals working in the emergency and psychiatric sectors are at the highest risk of workplace violence. In fact, healthcare professionals in the psychiatric setting have a higher risk rate of facing workplace violence opposed to other healthcare settings. Workplace violence can lead to adverse physical and psychological outcomes and impact the quality of care provided to patients. ObjectiveThis study aims to explore nurses' experiences with workplace violence and the impact of violence on nurses. Whereas the objectives of this study are to explore and analyze mental health nurses' experiences with workplace violence in Brunei Darussalam, identify and explore the impact of violence on mental health nurses, and discuss nurses' coping mechanisms following a workplace violence experience. DesignQualitative explorative study. Setting(s)Mental Health Unit Kiarong of Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam. ParticipantsNurses (n = 12). MethodsData was collected by conducting individual via online platforms. The interviews were carried out in English and/or Malay, the verbatim transcripts produced were transcribed in their source languages and only relevant excerpts were translated into English for the write-up. The data were analyzed utilizing thematic analysis by the researcher independently. ResultsThis study identified three themes: Violence as a norm in the psychiatric setting, perceived impact of workplace violence, and “Talk, Report and Accept” as Coping mechanisms. ConclusionsIn conclusion, it is apparent that globally workplace violence is normalized in the nursing industry, especially in the psychiatric setting. Workplace violence yields a plethora of negative long-term and short-term impacts on nurses. Despite this, workplace violence often goes unreported for numerous reasons but mainly due to the lack of changes after reporting. Nurses should be encouraged to report all instances of workplace violence by demonstrating effective changes and providing hazard pay. The management should actively attempt to reduce the risk of workplace violence by preemptively equipping nurses with the necessary training including identification of potential risks of workplace violence, effective de-escalation methods, and proper control and restraint methods.

Experiences of violence among people with stimulant use disorder in psychiatric inpatient settings: A qualitative study.

To describe the perspectives of those with lived experience of stimulant use disorder on methamphetamine-related violence in psychiatric inpatient settings. Eight adult psychiatric inpatients with stimulant use disorder were recruited. Semi-structured interviews were recorded, transcribed and analysed using thematic analysis. Participants reported that traumatic experiences predisposed those using methamphetamine to violent behaviour. Participants were fearful of psychiatric hospitalisation because of loss of autonomy and stigma. Methamphetamine use was associated with mercurial intense emotions. Participants believed these factors led to violence during psychiatric admissions. People with stimulant use disorder have a sophisticated understanding of the complex causal pathways from methamphetamine use to violent behaviour. Their lived experience can make an important contribution to service development.

'You have to be a certain sort of person': An interpretative phenomenological analysis of mental health support workers' experiences of physical restraint in inpatient settings.

Physical restraint is a controversial practice in psychiatric inpatient settings. Research has clearly demonstrated its physical and psychological risks, but few studies investigate how mental health support workers understand their experiences of restraint use. This study uses interpretative phenomenological analysis to explore support workers' understanding of these experiences. The COREQ checklist was used to ensure explicit reporting of the study. Semi-structured interviews were conducted with three participants and were then analysed using an interpretative phenomenological process. One superordinate theme emerged: 'You have to be a certain sort of person'. Restraints require not only the ability to overcome one's emotions, but also the ability to connect with the person being restrained. The implications of these findings for psychiatric care provision and for further research are discussed.

Increasing Early Cardiac Screening in an Inpatient Psychiatric Setting Using the KardiaMobile 6 Lead Device

AimsThe Royal College of Psychiatrists' core standards include a comprehensive physical health review as a vital part of an inpatient admission.To determine whether using the KardiaMobile 6 lead (KM6L) device on an inpatient psychiatric ward would increase: a.the percentage of patients who receive an ECG during an inpatient stayb.the percentage of patients who receive an ECG within 24 hours of admissionMethodsThe KM6L device provides a 6 lead ECG recording within 30 seconds. It enables ECGs to be performed more efficiently and less intrusively than a 12 lead ECG machine.The study aimed to offer all patients (101) admitted to an acute inpatient ward (July 2022 – Jan 2023) an ECG using the KM6L device, unless reporting chest pain, having significant cardiac history, or doctor otherwise concerned – in that event a 12L ECG would be done instead.The percentage of patients receiving an ECG during an inpatient stay and the percentage who received an ECG within 24 hours of admission were compared on the same ward when using: a.the KM6L device between July 2022 and Jan 2023; andb.a 12L ECG between July 2021 and July 2022QT intervals were calculated manually as the automatic feature is still in developmentResultsBetween July 2021 – July 2022, using a 12L ECG: •217 patients admitted•142 (65.4%) had a 12L ECG during their inpatient stay. Of these, 83 were done within 24 hours of admission (58.5%). Overall, 83/217 (38.2%) of patients had an ECG within 24 hours of admission.Between July 2022 – Jan 2023, when KM6L device available on ward: •101 patients admitted•66* (65.3%) had an ECG during their inpatient stay. Of these, 46 were done within 24 hours of admission (69.7%). Overall, 46/101 (45.6%) of patients had an ECG within 24 hours of admission*Note: 15/66 patients had a 12L ECG as available clinician did not know how to operate KM6L deviceConclusionKM6L, despite being easier to use and less intrusive, did not increase the percentage of patients who received an ECG during an inpatient stay. However, there was a notable increase in the percentage of ECGs performed within 24 hours of admission. KM6L offers a cost and time saving alternative for obtaining ECGs; earlier cardiac screening may also reduce risk.Future work will consider further training of healthcare professionals in how to use the KM6L device and expand its use across healthcare settings.

Voluntary and coercive covert trading behaviour on low and medium secure psychiatric units: a cross-sectional study

ABSTRACT Little is known about covert trading behaviour in secure hospital settings. This study evaluated the nature, prevalence, and frequency of covert voluntary trading behaviour (VTB) and of coercive trading behaviour (CTB) between patients in secure psychiatric units. Ninety-six eligible patients in 18 low or medium secure wards across South London anonymously completed a questionnaire exploring their experiences of covert trading behaviour (including exchanging, lending, borrowing, or gifting personal property, money, or services) during their current hospital admission. About 70.2% reported engaging in some form of unauthorised VTB (38.3% ≥5 different behaviours). VTB was more commonly reported by male (74.7%) than female (36.3%) participants (odds ratio (OR) = 4.93, 95% confidence intervals (CI) = 1.28,19.05, p = 0.021). Engagement in any CTB behaviour was reported by fewer patients (31.9%). Participants were significantly more likely to report themselves as victims of coercive behaviours (8.6%–14.0% across different behaviours) rather than instigators (1.1%–5.5% across behaviours). Involvement in CTB was more common in patients reporting VTB (39.4%) compared to those not involved in VTB (14.3%; OR = 3.90, CI = 1.21,12.54). Covert patient trading appears commonplace in secure psychiatric inpatient settings and VTB participation may be linked with CTB engagement. Hospital policies to better monitor and regulate patient trading may help to reduce the incidence of CTB.

Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures.

Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.

Commentary on “Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England”

PurposeThis commentary explores the challenges and themes enumerated by the associated article “Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England”. This commentary broadens and outlines the research’s background, premise and potential impact. This paper aims to critically examine the evidence on this subject.Design/methodology/approachThis commentary considers the attitudes to inpatient care for people with learning disabilities in the past decade and outlines a possible compact for the future.FindingsContrary to popular and emotive beliefs that using specialist inpatient psychiatric settings for people with learning disabilities is universally a poor practice, there are defined occasions when such settings are needed and imperative in the clinical pathway. If people with learning disabilities can access inpatient settings at the right time for the right reason, psychiatric outcomes could be improved. Timely discharge is imperative and currently lacking due to a lack of suitable engagement mechanisms between inpatient settings and the community. Thus, evidence-based outcome tools are essential to facilitate appropriate discharge.Originality/valueThere is an ongoing debate on the value and utility of specialist inpatient psychiatric units for people with learning disabilities. This commentary provides a balanced, evidence-based insight into this discussion.

Mild Vitamin C Deficiency Is Common in the Inpatient Psychiatric Setting.

Objective: Mild vitamin C deficiency is a psychiatrically relevant nutritional state, with symptoms including apathy, fatigue, and low mood. Although complete vitamin C deficiency has largely been eradicated, mild deficiency remains common in certain populations. Here, we aimed to identify the prevalence of mild vitamin C deficiency in the inpatient psychiatric setting.Methods: We identified 221 patients with plasma vitamin C levels collected on an inpatient psychiatric unit serving a metropolitan area between January 1, 2015, and March 7, 2022. We identified demographic (age, sex, race, housing status, Area Deprivation Index [an index of neighborhood disadvantage]), substance use (tobacco use, alcohol use), diagnostic (depressive, bipolar, psychotic, anxiety, substance use, catatonia, neurocognitive, autism spectrum), and micronutrient (folate, vitamin B12, vitamin D) risk factors. DSM-5-TR was used as the diagnostic system. Bayesian log-normal regressions were constructed to predict vitamin C as a function of these risk factors. We used these same models to predict vitamin C as a function of significant risk factors.Results: We found that 64% (141 of 221; 95% confidence interval 57%-70%) of patients met criteria for mild vitamin C deficiency. While we did not identify robust demographic, substance use, or diagnostic-based risk factors, we found that folate and vitamin D strongly predicted vitamin C levels. To test the utility of these predictors, we simulated vitamin C as a function of folate and vitamin D and found that predicted deficiency remained high (∼ 50%-55%), even when folate/vitamin D were sufficiently replete.Conclusions: We find that vitamin C deficiency is highly prevalent in the inpatient psychiatric setting and remains high even when the relevant risk factor profile is favorable.

A scoping review of institutional policies and recommendations for trans inpatient mental health care.

INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.

A Study of Cardiac Outcomes After Droperidol Administration in an Inpatient Psychiatric Cohort.

Droperidol is an antipsychotic medication used in psychiatric emergencies to manage acute behavioral disturbance. Droperidol use carries a risk of prolonged QT interval on the electrocardiogram and associated cardiac arrhythmias including torsades de pointes and ventricular fibrillation. This study aimed to evaluate the safety of droperidol in adults admitted to the psychiatric inpatient unit of a large Australian hospital. In this retrospective cohort study, psychiatric inpatients admitted between October 22, 2018, and March 1, 2021, who received at least 1 dose of intramuscular droperidol were consecutively included. Outcomes of interest were death, cardiac arrhythmias, and QT prolongation. QT prolongation was identified using the QT-interval nomogram. This study included 263 patients without exclusion. No deaths or cases of cardiac arrhythmia were recorded within 24 hours of droperidol administration. Electrocardiogram data were available for 41.1% of patients (n = 108) within 7 days of droperidol administration. Two cases of QT prolongation were identified using the QT-interval nomogram, but these patients were also prescribed other medications that may have contributed to QT prolongation. This study contributes the first known large retrospective study of safety outcomes including QT prolongation after droperidol administration in a psychiatric inpatient setting. Our findings corroborate mounting evidence supporting the clinical safety of droperidol use in psychiatric settings. Nonetheless, we note that significant barriers remain with regard to timely electrocardiogram monitoring after droperidol use.

IL-4 as a potential biomarker for differentiating major depressive disorder from bipolar depression.

We aimed to investigate the differential diagnosis of depressive episodes in patients with major depressive disorder (MDD) and bipolar disorder (BD) using peripheral blood cytokine expression levels. The levels of interleukin (IL)-2, IL-6, IL-10, IL-17, IL4, and IL-12; interferon (IFN)-γ; and tumor necrosis factor (TNF)-α were measured in patients with MDD and BD presenting acute episodes in an inpatient psychiatric setting. The expression levels of IL-6, IL-10, IL-17, and IFN-γ in the MDD and BD groups were higher than those in the control group (P < .05), but there was no significant difference between the patient groups and control group. Only the expression levels of TNF-α and IL-4 were higher in both groups than in the control group, and the BD group had higher levels than the MDD group (P < .05). The expression levels of IL-17, IFN-γ, IL-10, and IL-4 were significantly higher in BD-related manic episodes than in BD-related depressive episodes (P < .05). IL-6, IFN-γ, TNF-α, IL-10, and IL-4 levels were higher in BD-related depressive episodes than in MDD-related depressive episodes (P < .05). The receiver operating characteristic curve test for MDD and BD and the area under the curve for IL-4 revealed good clinical predictability. Patients with MDD and BD exhibited different cytokine profiles when experiencing acute episodes; patients with BD exhibited a more severe immune-inflammatory response system-compensatory immunoregulatory response system (CIRS) imbalance. IL-4 was found to have diagnostic value in differentiating between active depressive episodes in MDD and BD.

Undetected eating disorders among adolescent psychiatric inpatients.

The aim of this study was to identify the prevalence of undetected eating disorders (EDs) among adolescent psychiatric inpatients and to investigate the association between clinical, psychiatric, and sociocultural factors and EDs. Between January and December 2018, patients aged 12-18 years, hospitalized for inpatient-level treatment were given the self-assessment questionnaires of the Eating Attitudes Test-26 (EAT-26), the Contour Drawing Figure Rating Scale (CDFRS), the Child Behaviour Check List, and Sociocultural Attitudes Toward Appearance Questionnaire-4 after their routine unstructured clinical diagnostic assessment on admission by a psychiatrist. Patients were reassessed after reviewing the psychometric assessment results. The prevalence of EDs among 117 psychiatric inpatients was 9.4%, all were female and all diagnosed with unspecified feeding and eating disorder. We showed that 63.6% of patients with EDs was diagnosed after the screening and not with the routine clinical interview. EAT-26 scores were weakly correlated with affective (r = 0.314, p = .001), anxious (r = 0.231, p = .012), somatic (r = 0.258, p = .005), and impulsive maladaptive behaviours (r = 0.272, p = .003). A formal ED diagnosis was positively associated with media pressure, (OR:1.660, 95% CI: 1.105-2.495) and oppositional defiance (OR: 1.391, 95% CI: 1.005-1.926), and negatively with conduct problems (OR: 0.695, 95% CI: 0.500-0.964). The CDFRS results were not different between the ED and non-ED groups. Our study suggests EDs remain a prevalent yet often overlooked diagnosis in adolescent psychiatric inpatients. Health care providers should screen for EDs in inpatient psychiatric settings as a part of routine assessment to improve the identification of disordered eating behaviours that often begin during adolescence.

Strengths Model-Based Nursing Interventions for Inpatients in Psychiatric Inpatient Settings Using a Seclusion Room: A Case Series Study

The use of coercive measures in psychiatric inpatient settings has been an important issue for many years. Nursing interventions based on a strengths model could enable a reduction in the use of these measures. This study aimed to describe the practice of nursing interventions using a strengths model for psychiatric inpatients who have been in seclusion for a long time. We also constructed a nursing model to minimize coercive measures. The participants were eight inpatients who had been in seclusion for a long time. Nursing interventions based on a strengths model were implemented in collaboration with nurses from six long-term care units in three psychiatric hospitals in Japan. For 4 of the 8 participants, the seclusion time decreased by 20-45%. However, for another 2, it increased by about 23-34%. An average decrease of 9.6% was observed, and the open observation time increased by 1.4 h per day on the seclusion days. When using this model, the nurses considered the effects of stimulating strengths. We believe this approach may promote inpatients' self-insight. Considering the perspective of stimulus adjustment might be useful for maximizing the positive effects of working on strengths.

Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences.

Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes. Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults. Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training. Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.

Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals.

Digital transformation is the adoption of digital technologies by an entity in an effort to increase operational efficiency. In mental health care, digital transformation entails technology implementation to improve the quality of care and mental health outcomes. Most psychiatric hospitals rely heavily on "high-touch" interventions or those that require in-person, face-to-face interaction with the patient. Those that are exploring digital mental health care interventions, particularly for outpatient care, often copiously commit to the "high-tech" model, losing the crucial human element. The process of digital transformation, especially within acute psychiatric treatment settings, is in its infancy. Existing implementation models outline the development of patient-facing treatment interventions within the primary care system; however, to our knowledge, there is no proposed or established model for implementing a new provider-facing ministration tool within an acute inpatient psychiatric setting. Solving the complex challenges within mental health care demands that new mental health technology is developed in concert with a use protocol by and for the inpatient mental health professional (IMHP; the end user), allowing the "high-touch" to inform the "high-tech" and vice versa. Therefore, in this viewpoint article, we propose the Technology Implementation for Mental-Health End-Users framework, which outlines the process for developing a prototype of an IMHP-facing digital intervention tool in parallel with a protocol for the IMHP end user to deliver the intervention. By balancing the design of the digital mental health care intervention tool with IMHP end user resource development, we can significantly improve mental health outcomes and pioneer digital transformation nationwide.

EHealth Use on Acute Inpatient Mental Health Units: Implementation Processes, Common Practices, and Barriers to Use.

Information technology to promote health (eHealth) is an important and growing area of mental healthcare, yet little is known about the use of patient-facing eHealth in psychiatric inpatient settings. This quality improvement project examined the current practices, barriers, implementation processes, and contextual factors affecting eHealth use across multiple Veteran Health Administration (VHA) acute mental health inpatient units.Staff from units serving both voluntary and involuntary patients (n = 49 from 37 unique sites) completed surveys regarding current, desired, and barriers to use of Veteran-facing eHealth technologies. Two subsets of respondents were then interviewed (high success sites in eHealth use, n = 6; low success sites, n = 4) to better understand the context of their eHealth use. Survey responses indicated that 20% or less of Veterans were using any type of eHealth technology while inpatient. Tablets and video chat were the most desired overall and most successfully used eHealth technologies. However, many sites noted difficulty implementing these technologies (e.g., limited Wi-Fi access). Qualitative analysis of interviews revealed differences in risk/benefit analysis and implementation support between high and low success eHealth sites. Despite desired use, patient-facing eHealth technology is not regularly implemented on inpatient units due to multiple barriers (e.g., limited staffing, infrastructure needs). Successful implementation of patient-facing eHealth may require an internal champion, guidance from external supports with experience in successful eHealth use, workload balance for staff, and an overall perspective shift in the benefits to eHealth technology versus the risks.

Perceptions of Saudi psychiatric mental health nurses’ roles in the inpatient mental health care setting

PurposeThe aim of this study is to investigate the roles of psychiatric mental health nurses during their work experiences in inpatient clinical settings.Design/methodology/approachA focus group of 10 graduate psychiatric nurses with more than two years’ practice in inpatient psychiatric settings reflected on their last six months’ work placements and continuous employment. The transcripts and field notes were analyzed through thematic analysis of inductive data.FindingsTwo main themes emerged: management roles and clinical roles. The participants reflected on caring activities and obstacles encountered in fulfilling their professional roles.Originality/valueMultiple practice issues emerged. The participants perceived that psychiatric nurse specialists are required to perform more caring functions than practicable in the inpatient setting due to an excess of noncaring duties, structural minimization of the caring role and inadequate training. They felt that many of the functions performed were not within their expectations of the caring role of a psychiatric nurse specialist and believed that changes in nurse education and attention to clarification of nurses’ roles might enhance the role they play in patient care.

Sexual assault in the inpatient psychiatric setting

Sexual assault in the inpatient psychiatric setting is a significant problem with serious, lasting consequences. It is important for psychiatric providers to appreciate the nature and magnitude of this problem to be able to provide an appropriate response when faced with these challenging scenarios, as well as to advocate for the implementation of preventive measures. This article provides a review of the existing literature regarding sexual behavior in the inpatient psychiatric unit, describing the epidemiology of sexual assaults in these settings, and exploring the characteristics of both victims and perpetrators, with a particular focus on factors of relevance to the inpatient psychiatric patient population. Inappropriate sexual behavior in inpatient psychiatric settings is common, however the varying definition of such throughout the literature serves as a challenge to clearly identifying the frequency of specific behaviors. The existing literature does not identify a way to reliably predict which patients are most likely to engage in sexually inappropriate behaviors on an inpatient psychiatric unit. The medical, ethical, and legal challenges that such cases present are defined, followed by a review of current management and prevention strategies, and suggested future directions for research.

Implementation and evaluation of STOPP/START criteria to address polypharmacy in older adults in an inpatient psychiatric setting

BackgroundThere is a scarcity of research in applying the Screening Tool of Older Person's Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria to older adults admitted to a psychiatric hospital. ObjectivesThe primary aim of this study was to determine the extent of polypharmacy in older adults admitted to a psychiatric hospital and to assess the number of STOPP/START triggers detected and recommended by pharmacists. Secondary objectives include evaluating if the STOPP/START criteria is a useful tool to improve prescribing in this setting by assessing the implementation rates of STOPP/START triggers. MethodsThis was a prospective, longitudinal study in a psychiatry inpatient setting. Data were collected over a 7-week period. Explicit informed consent was obtained from participants. Medication reconciliation was completed and participants' medications were reviewed using STOPP/START criteria. The number of STOPP/START triggers detected, recommended and implemented was recorded. ResultsSixty-two patients were included in the study. Ninety-four percent were prescribed ≥5 medications and 55% were prescribed ≥10 medications on admission. The mean number of medications prescribed per patient increased from 10 on admission to 12 at follow-up. Of 174 Potential Inappropriate Medications (PIMs) detected, 41% were recommended for review and, of these only 31% were implemented. 27% of the 77 Potential Prescribing Omissions (PPOs) detected were recommended for review and only 23% of those were implemented. ConclusionSTOPP/START did not reduce the prevalence of polypharmacy in this setting. The implementation rates observed in this study were much lower than those observed in non-psychiatric settings.