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INTRODUCTION

NABP and DOB Data Collection

PULSE: 3/31/2021 - To Restart, or Not Restart, That is the Question: An Inpatient Monologue on Home Psychotropic Medications

QUIZ

EVALUATION

CERTIFICATE

INTRODUCTION

Credit Hours: Pharmacy 1.00

Target Audience:

Who should attend:

  • Clinical faculty from the University of Pittsburgh School of Pharmacy
  • Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
  • Student pharmacy interns currently working within the department of pharmacy
  • Certified Pharmacy Technicians

Abstract
During an acute illness requiring hospitalization, medications for chronic conditions often are not appropriately restarted or unintentionally discontinued. Of the different classes of medication, psychotropic medications are at even higher risk for not being appropriately restarted due to the belief that these are not pressing medications during critical illness and psychotropic medications can confuse the mental status of the patient. Additionally, psychiatric patients are often medically complex thus increasing polypharmacy complications such as more drug interactions and medication management.

Nonetheless, holding psychotropic medications does not go without risks. When psychotropic medications are held, patients can have short-term complications such as withdrawal symptoms, and acute decompensation of their mental illness that may result in a longer hospital stay. Additionally, the withdrawal effects of these medications can also contribute to patients’ mental status, which creates the controversy around whether these medications should be continued or not. This presentation seeks to review the prevalence, impact, and risks of holding medications during inpatient hospitalization, identify medical situations in which holding psychotropic medications should be considered, and discuss approaches to restarting home psychotropic medications appropriately and safely.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

  • Describe the prevalence and impact of medication errors at discharge due to holding of medications during inpatient admission
  • Discuss potential risks of holding psychotropic medications during inpatient hospitalizations.
  • Identify medical situations in which holding psychotropic medications should be considered.
  • Discuss approaches to restarting home psychotropic medications during inpatient admission.
Pharmacy Continuing Education Credits
This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is JA4008223-0000-23-089-H05-P. 

This module is a webcast of an ACPE approved live presentation. The minimum credit awarded for this module (1 contact hour) is determined by the length of the entire live presentation inclusive of the post-test.

Suggested Additional Reading:

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  3. Bell CM, Rahimi-Darabad P, Orner AI. Discontinuity of chronic medications in patients discharged from the intensive care unit. J Gen Intern Med. 2006 Sep;21(9):937-41. doi: 10.1111/j.1525-1497.2006.00499.x. PMID: 16918738; PMCID: PMC1831608
  4. Li M, Chang MH, Miranda-Valdes Y, Vest K, Kish TD. Impact of early home psychotropic medication reinitiation on surrogate measures of intensive care unit delirium. Ment Health Clin. 2019 Jul 1;9(4):263-268. doi: 10.9740/mhc.2019.07.263. PMID: 31293845; PMCID: PMC6607949.
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  6. Quélennec B, Beretz L, Paya D, Blicklé JF, Gourieux B, Andrès E, Michel B. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013 Sep;24(6):530-5. doi: 10.1016/j.ejim.2013.02.007. Epub 2013 Mar 18. PMID: 23514919., Smith JD, Raha D, Min S. Posthospital Medication Discrepancies: Prevalence and Contributing Factors. Arch Intern Med. 2005;165(16):1842–1847. doi:10.1001/archinte.165.16.1842
  7. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005 Jun;33(6):1266-71. doi: 10.1097/01.ccm.0000164543.14619.00. PMID: 15942342.
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  11. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed March 12, 2021.
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Authors:
Tuyen Nguyen, PharmD, MPH — PGY1 Pharmacy Resident, UPMC Western Psychiatric Hospital
No relationships with industry relevant to the content of this educational activity have been disclosed.
No other members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships with any companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

The certificate issued at the end of this course is not official, it only indicates you obtained a passing grade for this activity.

The ACPE and the National Association of Boards of Pharmacy (NABP) have developed a continuing pharmacy education (CPE) tracking service, CPE Monitor, that will authenticate and store data for completed CPE units received by pharmacists and pharmacy technicians from ACPE-accredited providers.

ACPE credit for participation in any pharmacist and/or technician achieved from this website is entered quarterly. Please allow 60 days from date of completion, for your credits to be added to the CPE Monitor.

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