Blanchfield Army Community Hospital Polypharmacy Clinic

AUTHORS: Kevin J. Ridderhoff, Jessica R. Hull, Sheila K. Sandberg

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SUMMARY:

The increased use of central nervous system depressants (CNSD) and psychotropics are one of the many factors that contribute to suicidal behavior in soldiers. U.S. Army policy requires medication screening for any soldier prescribed 4 or more medications when at least 1 of the medications is a CNSD or psychotropic. Constant deployments challenged health care provider ability to comply with required screenings, and senior leaders sought proactive intervention to reduce medication risks upon return of the 101st Airborne Division (Air Assault) from deployment in 2011.

A pharmacy-led team established the Polypharmacy Clinic (PC) at Blanchfield Army Community Hospital. Of the 3,999 soldiers assigned, 540 (13.5%) met the initial screening criteria. Success of the pilot program led to the mandatory screening of all other Fort Campbell, Kentucky, brigades. During the first 12 months, 895 soldiers were seen by a clinical pharmacist, and 1,574 interventions were documented. Significant interventions included medication added (121), medication changed (258), medication stopped (164), lab monitoring recommended (172), adverse reaction mitigated (41), therapeutic duplication prevented (61), and drug-drug interaction identified (93). Additionally, 55 soldiers were recommended for temporary duty profiles based on their adverse drug effects. Ten soldiers were recommended for enhanced controlled substance monitoring.

Placing soldiers on clinically appropriate medications and removing potentially harmful medications from their possession are examples of how the PC positively impacted the Commanding General’s ability to deploy a fully medically ready force. Soldiers consistently remarked favorably on the thorough medication counseling provided at their PC appointments. Innovative notes within the electronic health record summarized relevant findings regarding soldiers’ medications, which allowed providers to quickly pinpoint and adjust medication regimens. With each identified high-risk soldier, we decreased the potential for postdeployment medication issues. Additionally, the PC generated over $70,000 in relative value units for the hospital.

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