2026 Eastern States Conference

Authors: Nuha Mahboob, PharmD; Olivia C. White, PharmD 

Objective:  
Understand the role of a pharmacist in transitions of care with Long-Acting Injectable Antipsychotics (LAIA) given on a Behavioral Health Unit (BHU) 

Self-Assessment Question:  
What phase of LAIA administration prescribed inpatient can pharmacists intervene to improve transitions of care on discharge? 
a. Diagnosis of condition
b. Administration of LAIA 
c. Counseling on side effects 
d. Outpatient appointment scheduling 

Background: 
Patients with serious mental illness (SMI) are often lost to follow up after being initiated on LAIAs inpatient. This study aims to develop a protocol to target opportunities for pharmacists in transitions of care for inpatients receiving LAIAs. 

Methods: 
This is a single-center two-phase cohort study of adult patients that received an LAIA inpatient during BHU admission (any phase in Phase I; initiation only in Phase II). Exclusion criteria included substance use, out-of-state patients, or more than one LAIA administered. The pre-implementation phase reviewed 50 patients admitted to the BHU from January 1-June 30, 2024 for best practice transitions of care. In the post-implementation phase, a pharmacist posted a note with PO to LAIA dosing and destination for follow-up doses. Patients were contacted via MyChart message or phone prior to their next injection with an offer to counsel. The primary outcome was percentage of patients that received clinical best-practice care for their LAIA. Secondary outcomes include: PO to LAIA dosing, discharge counseling, follow-up scripts, appointments, and dose completion, and 60 day readmissions. This quality improvement project does not require Institutional Review Board (IRB) approval. 
 
Results: 
14 patients met criteria for Phase II. Three patients have been evaluated post-discharge thus far. Patient 1 completed their follow-up injection at the appropriate due date per chart review. Patient 2 confirmed they had an appointment scheduled with their clinic to receive their next dose. Patient 3 felt unwell on the LAIA and did not attend their follow-up appointment. Two of three patients were unable to be counseled prior to discharge.  All three patients received appropriate PO to LAIA transition. Upon complete data collection, patients will be evaluated for ideal transitions of care with subgroup analysis performed on readmitted patients. Patients will then be compared to a random selection of patients from Phase I. 
 
Conclusions: 
This study highlighted multiple areas of opportunity with LAIAs where pharmacists can intervene. Pharmacotherapy notes have helped guide care to stop unnecessary PO overlap, dosing first generation LAIAs, and send scripts to appropriate pharmacies. Discharge and post-discharge counseling can be beneficial for education. Next dose reminders are integral for standardization of the discharge protocol.  These pharmacist-led interventions are crucial for improving adherence in patients with SMI.