Developing a pharmaceutical care screening tool for use by acute mental health clinical pharmacy services

Abstract

Background: Mental health inpatient pharmacy teams in the UK are under pressure to deliver optimal care despite limited resources and staff shortages. Prioritising clinical pharmacy services is an innovative approach that aims to optimise the use of pharmacy expertise and reduce the incidence of Drug Related Problems (DRPs). Patient prioritisation tools have been developed and shown to be effective in improving patient outcomes and service delivery in acute care. Such approaches are much needed in mental health hospitals where medications are the main therapeutic intervention and patients are highly vulnerable to DRPs due to factors such as cognitive impairment. Research aim: The aim of this research programme was to develop a pharmaceutical care screening tool for use by acute mental health clinical pharmacy services. Methods: A systematic review was undertaken to identify risk factors for DRPs in hospital based mental health units. This was followed by a multi-method study where all mental health NHS trusts and boards in the UK were surveyed to identify organisations using pharmaceutical patient prioritisation approaches. Identified organisations were invited for follow up interviews and to provide their prioritisation documents for analysis. The third step towards the tool development was two sequential Delphi questionnaires, informed by the systematic review and the multi-method study, aiming to reach agreement on the content and design of the tool. Lastly, iterative acceptability testing was undertaken where mental health pharmacy team members from five NHS organisations tested the developed tool and provided feedback through reflection sheets and focus group discussions. Qualitative data was analysed thematically using NVivo software and quantitative data was summarised using Microsoft Excel. Results: A total of 22 studies were included in the systematic review. Identified risk factors included increased number of prescribed medications, advanced age and length of hospitalisation. The multi-method study identified 21 (n=21/55, 38.2%) organisations using patient prioritisation systems. A total of 15 interviews were conducted and 11 prioritisation documents were received. Identified systems varied greatly in their development, use, and complexity. A total of 36 experts completed the first round of Delphi study one (agreement reached on inclusion of 43.1% (47/109) of the risk indicators) and 29 completed the second round (agreement reached on inclusion of 66.7% (82/123) of the risk indicators). Experts agreed on using the traffic light system (red, amber, and green) to classify patients into risk groups. For Delphi study two, 32 experts completed the first round (agreement reached on inclusion of 41.3% of statements) and 30 completed the second round (agreement reached on inclusion of 44.8% of statements). The developed tool was generally acceptable by pharmacy professionals from five NHS organisations and participants’ feedback helped refine it further. Conclusion: This PhD programme developed an evidence- and consensus- based patient prioritisation tool accompanied by a manual and training material for mental health pharmacy teams. This tool may enhance clinical decision-making and help achieve the shared objectives of the mental health outcomes strategy “No Health Without Mental Health”. Future work may help further explore the tool’s feasibility and effectiveness and assist in determining its usability and future potential across diverse contexts.

Date of Award	25 Jun 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Richard Keers (Supervisor) & Penny Lewis (Supervisor)