Studying the Impact of Pharmacist-Driven Tardive Dyskinesia Screening

In this Q&A session, Niyati Butala, clinical psychiatric pharmacist, Riverside University Health System, Riverside, CA, discusses findings from the prospective quality improvement study “Impact of a pharmacist-driven tardive dyskinesia screening service,” which Butala co-authored.

Butala and co-researchers aimed to study the effectiveness of a psychiatric pharmacist-driven tardive dyskinesia screening service.

Question: What led you and your colleagues to investigate the impact of a pharmacist-driven tardive dyskinesia screening service? 

Answer: This prospective quality improvement study was conducted in a 77-bed locked psychiatric inpatient teaching hospital. Given the underuse of the AIMS and TD monitoring disparities among providers, this study aimed to assess the impact of a psychiatric pharmacist–driven TD screening service (PPDTSS) on TD monitoring rates and risk stratification in an inpatient psychiatric setting 

Q: Please briefly describe the study method and participants.    

A: The preintervention, or control, group included patients 18 years and older who were admitted to the inpatient treatment facility from the emergency department for at least 1 day, taking at least 1 antipsychotic during admission, and discharged from the treatment facility between May 20, 2018, and August 20, 2018. The postintervention, or intervention, group consisted of patients 18 years and older on admission who were admitted for at least 1 day to the inpatient treatment facility between August 20, 2018, and November 20, 2018. Patients had to satisfy the criteria as outlined in the screening tool, be able to follow directions, and not be aggressive or too disorganized as identified by the charge nurse and behavioral health specialist on the unit at the time of the AIMS screening. All patients admitted to the unit for more than 24 hours were screened daily using the TD screening tool by the clinical pharmacist. Patients with 3 or more risk factors were then assessed for TD with the validated AIMS by the pharmacist 

Q: Please briefly describe the most significant finding(s).   

A: The control group consisted of 402 patients, with 103 patients (25.6%) having 3 or more risk factors for developing TD. Of these patients who were deemed higher risk, only 15 (14.6%) were assessed for TD via AIMS, and 2 were screened as positive. The postintervention group consisted of 390 patients who were screened using the TD screening tool. Of those screened, 75 (19.2%) had 3 or more risk factors for developing TD, and all (100%) were assessed for TD. The AIMS was completed for 46 patients (61.3%), and 3 (6.5%) were positive for TD. 

Q: Were any outcomes different than you expected?   

A: We expected some relation of the number of risk factors to correlate with the increased risk of TD, but there was no relation which we did not expect. 

Q: What are the practical applications of your findings for clinicians treating patients with tardive dyskinesia? 

A: The results of this study demonstrate that nonphysicians can help assess TD and help physicians stay in compliance with the APA guidelines. 

Q: What are the practical applications of your findings for psychiatric pharmacists? 

A: The results of this study demonstrate that psychiatric pharmacists can be used to improve the regular monitoring of patients at high risk for TD. The TD screening service increased patient access to a pharmacist, which resulted in additional recommendations provided to the treatment team to optimize care. Recommendations included referrals to dietitians, changing the formulation of medications to increase adherence, reinitiating home medications, addressing potential side effects from medications, and providing patient education.

Q: Are you conducting any more research in this area, and are there any other studies you feel are needed? 

A: We are currently not researching TD in specific but there are very limited number of studies addressing risk factors for TD as well as nonphysicians helping to assist with screenings which should both be further assessed.  

Q: Any final thoughts pertaining to this research? 

A: While this study did not increase the number of VMAT2 inhibitors used, but it increased the effective recognition of TD risk factors and management of TD and contributed to improved medication management by incorporating psychiatric pharmacists on the units. Psychiatric pharmacists can be used as a resource to improve TD monitoring rates within an inpatient setting. 

Niyati Butala is a clinical psychiatric pharmacist at Riverside University Health System. Butala graduated from Massachusetts College of Pharmacy and Health Sciences in Boston, Massachusetts in 2017 then pursued by PGY1 residency at Mount Auburn Hospital in Cambridge, Massachusetts and PGY2 residency at Riverside University Health System.