1. Collecting the Demographic Data: Interview the patient and obtain a thorough medication history from a patient that provides adequate information to conduct a comprehensive medication review. This information will include patient’s demographics, past and current medical history and social history.
2. Identifying the Drug Record: The drug record is a comprehensive record of the patient’s medications (prescription and nonprescription medications, herbal products, illicit drugs and other dietary supplements). Care should be made to identify and list all the patient’s medications.
3. Identifying and Analyzing Potential Drug-Related Problems: Use the tool to identify potential drug related problems. Responses should be detailed enough to demonstrate the student’s thorough and detailed analysis of the patient’s problems. Use scholarly references to support your findings.
a. Adherence/Non-adherence issues
b. Indications/Therapeutic goals
c. Safety concerns
d. Effectiveness of the medication
4. Developing a Drug-Related Action Plan: The medication-related action plan (MAP) is a patient-centric document containing a list of actions for the patient to use in tracking progress for self-management and shared goals.
5. Formulating an Intervention and/or Referral: The PMHNP provides consultative services and intervenes to address drug-related problems. The PMHNP refers the patient to a physician or other healthcare professional, as needed. Referrals are expected when the patient’s needs are outside of the PMHNPs scope of practice or the practitioner lacks adequate skills to address them.
6. Include a title page.
7. The paper does not need an introductory paragraph, purpose statement, or a conclusion. Students will follow the tool as a guide to structure the paper.
8. Include level 1 headings to organize the paper.
9. As this is a reflective paper, first person may be used.
10. Include a minimum of five (5) professional peer-reviewed scholarly journal references to support the paper (review in Ulrich Periodical Directory) and be less than five (5) years old.
11. APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).
12. Submit by the posted due date.
Patient’s Demographic Data
TD is a 66 -year-old African American male brought to the hospital by his daughter for psychiatric evaluation after experiencing a psychotic episode. The daughter claims that TD has been exhibiting auditory hallucinations for the past week. He claims to hear voices while he is alone and idle at home, warning him of his neighbors’ intent to harm him. Today the patient had an angry outburst in a food store and became violent towards a group of teens that he claimed were out to harm him. The food store security officers restrained the patient, and her daughter was contacted, who brought him to the hospital.
TD has a health history of paranoid Schizophrenia, diagnosed six months ago when he presented with hallucinations and delusions revolving around some group of people spying on him with the intent to steal his property. The patient is currently on a twice-daily 500mg dose of Chlorpromazine, prescribed six months ago to manage Schizophrenia. The patient reports that he took his last doze two weeks ago because he was out of medication and planned to visit the clinic for a refill but had not yet got the time due to a busy schedule. He claims that he is somehow relived the prescription got depleted because it gave him a break from the gastrointestinal problems, he usually experiences a few hours after taking the drugs. He also reports that he has delayed the refill because his insurance is outdated, and he doesn’t think a few days off the medication would cause any harm. All the patient immunizations are up to date, and he does not have a significant history of hospitalization or surgical history. The patients deny tobacco use or illicit drugs but report taking at least 500 ml bottle of alcohol every evening before bed. Th patient is widowed and lives alone, although her daughter visits occasionally.
The patient is currently on Chlorpromazine, a first-generation antipsychotic prescribed six months ago to manage Schizophrenia. He also takes alcohol occasionally to manage Schizophrenia symptoms. The patient denies using tobacco or illicit drugs.
Potential Drug-Related Problems
In assessing and treating mental illnesses, it is essential to assess the potential drug-related problems that may contribute to worsening the disease symptoms, relapse, and rehospitalization. Several factors can be used to analyze the potential drug-related problems in assessing and treating a patient with Schizophrenia. Understanding these issues is the first step to designing an effective treatment plan.
- Adherence and non-adherence issues
Antipsychotic medications are an essential part of the treatment of Schizophrenia because they are highly effective in managing the symptoms and preventing the risk of relapse and rehospitalization. They also help rehabilitate the patient back to the society by preventing risk of harm to others. However, non-adherence is a significant problem among patients with Schizophrenia. Adherence describes a patient’s behavior towards taking the prescribed medication regarding correct timing, dosage, and duration. Studies indicate that non-adherence to antipsychotics ranges from 20 to 89% for patients with Schizophrenia (Kavoor, 2020). Therefore, to reduce non-adherence in patients with severe mental disorders, it is necessary to know more about the reasons for non-adherence and implement factors to influence adherence positively.
In the current case, the patient was diagnosed with Schizophrenia six months ago and prescribed an antipsychotic drug to manage the symptoms. The patient has not had any episodes of relapse or rehospitalization throughout the six months because he has been adhering to the treatment plan. However, the patient reports that he took his last dose of the antipsychotic drug two weeks ago and is out of drugs, and has not yet sought a refill. Following this non-adherence to the treatment plan, the patient was hospitalized with a relapse of Schizophrenia. Several patient factors have contributed to the non-adherence. First, the patient reports that he has not yet sought a refill because he does not think skipping the prescription for just a few days will cause any harm. This indicates limited literacy and knowledge regarding how the treatment plan works and the potential effects of poor adherence to the recommended treatment plan. It indicates the need for health education regarding the treatment plan. Secondly, the patient reports experiencing financial difficulties, as his insurance was outdated. This indicates an inability to afford the prescription drug, thus needing support in purchasing the prescription. Thirdly, the patient reports being widowed, living alone, and receiving an occasional visit from her daughter. this indicates limited social support and the need for a caregiver
- Indications/ therapeutic goals
Another essential aspect of assessing patients with Schizophrenia is the assessment of the attainment of the therapeutic goals. The primary treatment goals in patients include managing symptoms, preventing relapse and increasing adaptive functioning so that the patient can be integrated back into the community. The assessment of the current patient indicates that since the prescription of the psychotic drug, the patient’s symptoms have been adequately managed. He does not report any major episode during that period. However, interventions to prevent relapse and ensure the patient can be integrated into the community have been inadequate. For example, the patient was brought today because he posed harm to the public in a food café. This was caused by a relapse, attributed to poor adherence to the treatment plan. It indicates a need to implement interventions to percent relapse.
- safety concerns
Assessing safety concerns in patients with Schizophrenia is essential in determining the effectiveness of the treatment plan, the onset of complications, and above all, determining the most appropriate treatment setting. It is also essential in determining the need for a care giver or admission in a psychiatric facility. Patients at significant risk of self-harm and causing harm to others are usually treated as inpatients because they require close monitoring by the care provider. In the current case, the patient does not report any safety concerns such as suicidal thoughts, suicide attempts, hopelessness, or the need to harm others. This indicates the patient can be treated as an outpatient
- Effectiveness of the medication
The effectiveness of the medication can be measured through improvement in clinical, symptoms, absence of contraindications, and drug side effects. In the current case, the patient has reported improvement in the Schizophrenia symptoms. However, he reports that he has been reluctant to refill the antipsychotic refill because he needed a break from the drug side effects. This indicates he needs to find an alternative prescription with minimal side effects, to encourage the patient to adhere to the prescription.
Developing a Drug-Related Action Plan
Drug-related action plans focus on developing a collaborative, timely program that will help the patient in managing Schizophrenia and reducing the aspect of relapse. The plan contains a list of actions for the patient to use in tracking progress for self-management. It helps resolve problems arising from the previous therapy, such as relapse, and improves a patient’s medication therapy appropriateness. The plan is intended to guide the patients, their family and care givers.
The first part of the plan is to take the medication as directed by the physician. This includes taking the correct dose simultaneously and for the proposed period. Drug underdose, overdose, or skipping increases the risk of relapse and drug side effects.
The second aspect of the plan is taking the entire course of the prescription, even if the symptoms disappear. The patient should understand that Schizophrenia requires lifelong treatment, even when symptoms have subsided. Therefore, the absence of the symptoms does not mean the condition is healed. If medication is terminated during this period, it may result in relapse.
The third aspect of the plan is avoiding terminating the antipsychotic prescription without informing the provider. This means that the patient should get a refill from the care provider when the initial prescription is depleted. The rationale is that terminating the prescription may cause relapse and withdrawal symptoms. The most common withdrawal symptoms for antipsychotics are abnormal skin sensations, aching muscles, and anxiety. These symptoms may aggravate the Schizophrenia, putting the patient at risk of self-harm and a danger to others.
The fourth aspect of the plan is to watch out for the side effects of the antipsychotic drugs. These include dry mouth, constipation, uncontrollable jaw movement, weight gain, and sexual problems (Siafis et al., 2018). These side effects are usually mild. However, if they become bothersome, the patient should not terminate the treatment. Instead, they should contact the care provider for medical intervention s and a change in the prescription.