Drug-use evaluation programs for psychotropic medications

Drug-use evaluation (DUE) programs for psychotropic medications at a state-operated mental health center are described. DUE programs were developed at Western Missouri Mental Health Center to monitor prescribing of medications in the hospital and ambulatory-care settings. DUE criteria were developed for all major groups of psychotropic medications: antipsychotics, antidepressants, antianxiety and hypnotic agents, lithium, and antiparkinsonian drugs. The criteria appear on special forms developed for the programs; pharmacists use these forms to evaluate every medication order for inpatients and every 50th medication order for ambulatory-care patients. Physicians are alerted to noncompliant prescribing practices by memorandum, oral consultation, or both. In 3204 inpatient DUEs conducted from July 1986 to December 1988, orders for antiparkinsonian drugs showed the poorest compliance with DUE criteria. In both the hospital and ambulatory-care settings, antiparkinsonian agents required the most follow-up. The overall compliance rate for inpatient DUEs was 84%; for ambulatory-care DUEs, the compliance rate was 64%. As a result of the ambulatory-care DUE program, basic laboratory studies and dyskinesia rating scales are being ordered on a more timely basis. These DUE programs have increased pharmacist monitoring of patient care and improved documentation of medication use.