Impact of a pharmacist-led mood stabilizer laboratory monitoring protocol

Several guidelines recommend ongoing clinical monitoring of mood stabilizers. However, only one-third to one-half of patients taking a mood stabilizer are appropriately monitored.

This study aimed to determine whether a newly implemented pharmacist-led laboratory monitoring protocol ensures guideline-recommended monitoring of mood stabilizers of inpatients with psychiatric disorders.

This quasi-experimental, prospective study took place at a single-center and evaluated 120 inpatient adults on a mood stabilizer of any dosage over a 3-month period. A newly implemented, pharmacist-led mood stabilizer laboratory monitoring protocol was used that allowed pharmacists to order guideline-recommended laboratory tests for patients taking a mood stabilizer for a mood disorder. The primary outcome was to identify the number of subjects with pharmacist interventions completed regarding laboratory monitoring of mood stabilizers with protocol utilization.

Pharmacist interventions regarding laboratory or therapeutic drug monitoring of mood stabilizers were completed in 54 of 120 total subjects (45%) included. Seventeen subjects had one or more monitoring tests outside the target parameter(s), regardless of who ordered it. The number of pharmacist recommendations made, other than laboratory intervention per protocol, was 24, of which 15 were accepted by providers (62.5%). Pharmacists ordered 76 tests per protocol including therapeutic drug levels (29.2%), lipid panels (19.2%), liver function tests (5%), thyroid function tests (5%), urinalyses (1.7%), complete blood counts (0.83%), electrolytes (0.83%), renal function tests (0.83%), and fasting glucose levels (0.83%).

In inpatients with psychiatric disorders receiving a mood stabilizer for a mood disorder, a pharmacist has a beneficial impact on mood stabilizer monitoring in accordance with guideline recommendations.