Gonzales Gillian, Tornes Kari, Saklad Stephen R
PGY1 Resident, VA Eastern Colorado Health Care System, Aurora, Colorado; previously: The University of Texas at Austin College of Pharmacy, San Antonio, Texas.
PGY1 Resident, University Health System, San Antonio, Texas; previously: The University of Texas at Austin College of Pharmacy, San Antonio, Texas.
Ment Health Clin. 2022 Nov 3;12(5):320-326. doi: 10.9740/mhc.2022.10.320. eCollection 2022 Oct.
Antipsychotic (AP) medications are prescribed for various psychiatric diagnoses that require routine monitoring to ensure optimal use, effectiveness, adherence, and for potentially severe adverse effects. There is currently no comprehensive protocol for institutional supervision of prescribing and monitoring AP. Antibiotics (ABX) are commonly associated with stewardship programs aimed at optimizing use and mitigating harm. These programs have proven to result in positive outcomes in both safety and efficacy parameters for numerous institutions. Given that AP are also associated with significant adverse effects and often misused, the concept of stewardship can be applied to this class of agents to optimize their use and improve overall patient outcomes. The objective of this paper is to provide guidance for the implementation of antipsychotic stewardship programs (APSP) in the inpatient setting. The development of this APSP was designed based on ABX stewardship programs and the Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and the American Psychiatric Association practice guidelines on the treatment of patients with schizophrenia. In conclusion, APSPs have the potential to enhance and standardize institutional supervision of prescribing and monitoring practices of AP, leading to improved clinical outcomes and the reduction of adverse effects. APSP teams should be multidisciplinary, consisting of clinicians and administrators, working in conjunction with patients and patient advocates to design individualized recovery plans that consider the individual patient's history and desired outcomes. Monitoring, stewardship interventions, and outcomes should be documented on both an individual and deidentified institutional basis, analyzed, and summarized periodically as measures for quality improvement.
抗精神病药物（AP）被用于多种精神疾病的治疗，这些治疗需要进行常规监测，以确保药物的最佳使用、有效性、依从性，并预防潜在的严重不良反应。目前尚无针对AP处方开具和监测的机构监管综合方案。抗生素（ABX）通常与旨在优化使用和减轻危害的管理计划相关联。这些计划已被证明能在众多机构的安全性和有效性参数方面产生积极成果。鉴于AP也会产生重大不良反应且常被滥用，管理理念可应用于这类药物，以优化其使用并改善患者总体预后。本文的目的是为住院环境中抗精神病药物管理计划（APSP）的实施提供指导。该APSP的制定是基于ABX管理计划以及疾病控制与预防中心、医疗保健研究与质量局和美国精神病学协会关于精神分裂症患者治疗的实践指南。总之，APSP有潜力加强和规范机构对AP处方开具和监测实践的监管，从而改善临床结局并减少不良反应。APSP团队应是多学科的，由临床医生和管理人员组成，与患者及患者权益倡导者共同协作，设计考虑个体患者病史和预期结局的个性化康复计划。监测、管理干预措施和结局应在个体层面以及经过去识别化处理的机构层面进行记录，定期进行分析和总结，作为质量改进的措施。
