Basic principles of psychopharmacologic treatment for advanced practice psychiatric nurses with prescriptive authority.

Over the past decade, a major trend in psychiatric care has been a greater emphasis on the biological aspects of psychiatric disorders, a rapidly expanding pharmacopoeia of efficacious psychotropic agents, and an increase in the use of psychopharmacotherapy in the treatment of mental illness. As mental health care delivery systems strive to address goals of cost containment, access to care, quality of care, and patient satisfaction, the expanded use of advanced practice psychiatric nurse prescribers is a logical conclusion, and prescriptive authority allows for the independence and the full scope of advanced nursing practice. This article outlines 11 basic principles of sound psychopharmacotherapy that can serve as guidelines for the achievement of optimal patient care and favorable patient outcomes.

An HMO psychopharmacology service.

A pilot HMO psychopharmacology service is described. The program utilized a consultant psychopharmacologist (14 hours per week on-site) and two master's degreed nurse-clinicians who spent four and eight hours per week treating psychopharmacology patients. The psychopharmacologist evaluated all patients, initiated drug therapy, and referred selected patients to the nurse-clinicians for follow-up. The latter functioned as independent clinicians, making treatment decisions and writing prescriptions (which were countersigned by the psychopharmacologist or other staff psychiatrists). Support services (e.g., emergency triage) were provided by the mental health department. At the end of one year, the service was managing a caseload of 184 patients, 64 of whom were being followed by the two nurse-clinicians). Patient acceptance was good, and the service was supported by other mental health and medical personnel, who viewed it in pragmatic terms of increasing access to care. Issues related to the implementation of such a service in HMO settings are discussed.

A consortium approach to nursing staff development.

Within a consortium framework, four teaching hospitals have developed a curriculum for nursing staff development. Since 1980, the institutions have realized significant savings. The courses provide networking and integration of new research and facilitate technological transfer. Other institutions may also find a collaborative approach beneficial.