Answer

Capstone Change Proposal: Medication Tracking to Lower Risk of Readmission

Non-adherence to psychotropic medications may lead to poor outcomes among mental health patients. It is proposed that medication tracking may help resolve the issue of medication non-adherence. Medication adherence allows healthcare providers to monitor and improve medication adherence, thus enhancing treatment outcomes such as lower risk of readmission. The PICOT (Population, Intervention, Comparison, Outcome, and Time) Question is: In mental health patients (P), can medication tracking (I) compared with no medication tracking (C) reduce the number of readmissions for patients within three (3) months (T) after receiving long-acting antipsychotic injections?

Purpose: The purpose of this paper is to propose a study that will determine whether the use of medication tracking systems can lower the risk of readmission of mental health patients (or not).  

Background

            Psychiatric disorders are considered as a significant global and a growing public health concern. 14% of the global burden of diseases are attributed to psychiatric disorders. Globally, psychiatric disorders affect about 450 million people. The most common psychiatric disorders include schizophrenia (21 million people), bipolar disorder (60 million people), and depressive disorders (350 million people) (Semaheng et al., 2018). In addition, psychiatric disorders account for about 31.7% of the years lived with long-term dependency and disabilities (Semaheng et al., 2018).

Psychiatric disorders are known to worsen due to poor healthcare coverage, ineffective treatments, and poor adherence. Medication non-adherence may lead to indirect economic costs such as premature mortality, unemployment, vanished production, absence from work, and misplaced resources (Semaheng et al., 2018). People who are diagnosed with mental health disorders experience double-risk of all-cause mortality compared with the general population (Dickens et al., 2019). It is essential to maintain medication adherence for realization of better treatment outcomes (Semaheng et al., 2018). Long-acting injectable antipsychotic medications were developed in order to simplify medication regiments through less frequent administration and decrease burden of frequent medication administration (Maestri et al., 2018).

Clinical Problem Statement

            Patients with psychotic disorders should adhere to a treatment plan including medication adherence for realization of better outcomes. However, this is not always the case. Most of mental health patients do not adhere to a given treatment plan leading to poor outcomes such as readmissions (Semaheng et al., 2018).

Literature Search Strategy

Evidence-based resources were drawn from peer-reviewed journals. Search terms that were used in search of evidence-based resources included psychotropic medications AND adherence; psychotropic medications AND non-adherence; medication adherence AND mental health conditions; medication non-adherence AND psychiatric disorders, and Chronic disease self-management AND model. Selection was based on relevance to the topic and articles written in English language. In addition, articles not older than 5 years were considered for inclusion. The author used quantitative, systematic reviews, meta-analyses, and qualitative studies. Recent evidence-based articles that were published as from 2015 to 2020 (with exception to year of publication of the utilized nursing theory) were selected to provide background, evidence, and context to this proposal.

Evaluation of the Literature

Poor medication adherence is a major challenge in treatment of psychotic disorders. Poor medication adherence continue to make psychiatric disorders to remain to be major public health problems, thus, becoming significant economic, social, and health burdens globally (Semaheng et al., 2018). Long-acting injectable antipsychotics delay or prevent hospital readmission in a patient with a known history of medication non-adherence. Medication tracking may enhance this outcome (Maestri et al., 2018). Non-adherence to medications may lead to premature death, poor mental wellbeing, and increased economic burden of the disease. Non-adherence can lead to exacerbation of the psychiatric disorders and various complications that can lead to poor psychosocial outcomes, re-hospitalization, relapse of symptoms, wastage of limited healthcare resources, poor quality of life, increase substance abuse, increased suicide, and reduced effectiveness of subsequent treatment (Semaheng et al., 2018). Medication tracking system is considered as having considerable benefits in improvement of patient’s adherence to medication regimes (Goold, 2019).

Lorig Kate’s (1996) Chronic Disease Self-Management Model

            Lorig Kate’s (1996) chronic disease self-management model was selected as the most appropriate model for this change project since it affirms that partnerships between patients and healthcare providers is necessary for improvement of a patient’s of self-management abilities. In this case medication adherence is seen as a function of the patient’s self-management abilities. According to Lorig (1996), patient education is an effective strategy for achievement of a desirable level of a patient’s self-management abilities. Similarly, education of both healthcare staff and patients will be utilized so as to improve outcomes of medication tracking.

Proposed Implementation Plan

            The plan of for implementation of this intervention will begin with equipping all hospitals and facilities that provide mental health services with essential hardware, software, infrastructure, human resources and systems for medication adherence. The next step would be to educate and train involved personnel on how to operate and use the systems to monitor medication adherence, assess outcomes, and other functionalities. The third step would be to will be to evaluate outcomes of the intervention compared to group of patients who were provided psychotropic medications but missed medication tracking services. The last step will be to ascertain sustainability and cost-effectiveness of the intervention plan.

Outcomes Measures

            Measurement of outcomes is a new strategy that results in realization of best outcomes with maximization of value for patients and for lowest cost (Pantaleon, 2019). Proposed measures of outcomes include reduced risk/incidence/rate of re-hospitalization, reduction of symptoms, patient functionality, cost of healthcare, and reduced length of hospitalization of mental health patients (Pantaleon, 2019). Other outcome measures included coming for injections at the planned dates, and number of patients who discontinue or dropout from the treatment plan (Semaheng et al., 2018).

Utilization of Evidence-based Practice

            Evidenced-based practice was used in creation of the intervention plan. Peer-reviewed evidence sources were used in development of an intervention. Medication tracking is a documented effective intervention for improving medication adherence and for improvement of treatment outcomes (Semaheng et al., 2018). In addition, review of evidence-based publications informed the intervention plan since they indicated that it a recommended intervention for improving better treatment outcomes in mental health practice (Semaheng et al., 2018). According to medication tracking system can help improve communication between healthcare providers and among healthcare professionals, thus, helping to build inter-professional collaboration and patient outcomes (Kern et al., 2019).

Plan for Evaluating the Proposed Nursing Intervention

            First of all, the proposed intervention will be evaluation from the perspective of the healthcare system. Hospitals and mental health institutions/facilities will be evaluated on whether they have adequate number of personnel to perform medication tracking roles as well as having appropriate tools, systems, software, hardware, and infrastructure (or not). Secondly, the plan will be evaluated measuring impacts or identified outcomes within a three month period after implementation. Lastly, but not the least, the plan will evaluated based on sustainability and cost-effectives of the intervention.

Potential Barriers to Plan Implementation

Prescription of Ineffective Medications

            Ineffective medications may complicate evaluation of outcomes since it may lead to further worsening of mental health conditions, poor adherence, poor treatment outcomes, and readmissions. It is imperative that healthcare providers must treat patients using established treatment guidelines and latest evidence-based guidelines (Semaheng et al., 2018).

Lack of Healthcare Coverage

            Lack of healthcare coverage may lead to exclusion of some mental health patients from medication monitoring services. Nurses should advocate for change of public health insurance policies to allow for federal and state coverage of all mental health patients regardless of their status (Semaheng et al., 2018).

Resistance to Change by the Nursing Staff

            Poor nurse attitudes about the intervention may be a potential plan. Nurses should be educated about the importance of medication tracking in promotion of better nursing outcomes (Dickens et al., 2019).

Breach of Patient’s Confidentiality and Privacy

            Patient’s confidentiality and privacy should be ensured through strict adherence to established regulatory guidelines. Existing regulatory guidelines are sufficient in addressing these concerns (Goold, 2019)