Forensic Psychiatric Pharmacy Practice at Atascadero State Hospital

Atascadero State Hospital (ASH) is the nation's largest maximum security forensic psychiatric hospital. Most patients are committed under penal codes as psychiatrically unstable prisoners, mentally disordered parolees, individuals found not guilty by reason of insanity, or individuals deemed incompetent to stand trial. Pharmacists' involvement in patient care and supportive activities at ASH are varied. Direct patient care activities include attendance at interdisciplinary treatment teams, medication consultation upon request of physicians or other staff, and follow-up on adverse drug reactions. Pharmacists may also be involved in discharge planning, especially for patients on clozapine treatment. Patient medication education is provided by pharmacists through medication management classes and discharge counseling. Indirect patient care activities include verification of data entry for automation of physician orders and drug regimen review (DRR) audits. Drug Use Evaluations (DUEs) and the Annual Survey allow tracking and improvement of prescribing patterns. Committees and Continuous Quality Improvement (CQI) activities throughout the hospital often include pharmacist members. Teaching is another important function of the pharmacist. Pharmacology classes are given to psychiatric technician students. Drug-induced movement disorder classes are provided to new employees. Additionally, pharmacy students on clinical clerkship rotations are trained and assist in providing clinical services. Capable technicians play a key role in allowing greater emphasis of time on clinical and administrative pharmacist functions. ASH provides the somewhat unique combination of clinically-oriented pharmacist positions in a rural community.