Read the PubMed-indexed journal article outlining psychotropic stewardship.

The article evaluates common traits of various effective medication management strategies and develops a framework for psychotropic stewardship programs (PSPs).

Introduction to Psychotropic Stewardship

The ultimate goal is that every patient with a psychiatric disorder, including substance use disorders, will have their medication therapy reviewed, optimized, and managed by a psychiatric pharmacist as part of a psychotropic stewardship team. In short, intentional efforts to have a Board Certified Psychiatric Pharmacist (BCPP) provide Comprehensive Medication Management (CMM) services to patients with psychiatric disorders will improve access, outcomes, and cost.

Patient outcomes improve when pharmacists are integrated at the system level

Programs that have similarly leveraged pharmacist expertise for systematic medication management consistently show:

  1. Improved medication safety and prescriber & patient satisfaction

  2. Reduced adverse drug events and polypharmacy

  3. Decreased annual healthcare cost, emergency department visits and hospitalizations

Core Elements of a Psychotropic Stewardship Program (PSP)

  1. Psychotropic Stewardship Team

    The team of multidisciplinary core members is co-led by a psychiatrist/physician and a BCPP, and it include a social worker, a psychiatric nurse, and most importantly the patient. Depending on the practice site, additional team members may include a primary care physician, a physician’s assistant, a psychologist, and/or involvement of an information system specialist .

  2. Health-System Collaboration

    To create a successful program, the psychotropic stewardship team must collaborate effectively with the health-system's leadership teams and key committees.

  3. Strategic Psychotropic Review

    For the psychotropic stewardship team, implementing the program will be driven by local needs, identified health-system areas for improvement, and available clinical resources. Ex: routine review of flagged psychotropic regimens, development of risk stratification criteria, ongoing formulary review with revisions, etc.

  4. Accountability

    The expectations and responsibilities of each team member should be clearly defined and communicated to ensure everyone is accountable for their role in the PSPs.

  5. Comprehensive Medication Management (CMM)

    The utilization of CMM will be a collaboration between all PSP clinical team members, using their unique strengths, skillsets, and expertise to optimize patient care.

  6. Supportive Technology

    Technology will aid in targeting interventions, identifying outcomes, obtaining and analyzing data, as well as reporting.

  7. Tracking

    Ongoing patient outcome and stewardship process tracking is crucial to the success of the PSP and team.

  8. Education

    In an effort to sustain the program and provide longevity, stewardship team members will be essential in providing ongoing education to various parties within the health-system. Academic detailing, reporting to relevant committees, leadership briefing, and reviewing quarterly outcome summaries are examples of how, and to whom, education material is delivered.

Getting Started

BCPPs are well-positioned to develop, implement, and lead PSPs to become a regulatory standard in all health-systems. Implementation of PSPs is a key component in the advancement of psychiatric pharmacy practice and will take time to develop. Initiation of a PSP may focus on high-risk medications, patients with documented medication non-adherence, patients with comorbid medical diagnoses, or high utilizers of health care resources. Patients meeting multiple criteria could be prioritized if necessary. Each PSP should determine the best criteria for implementation to ensure patients receive the care they need while also balancing limited resources.