Effect of an RN-Led Medication Teaching Initiative on Psychiatric Recidivism

• Published in: Issues in mental health nursing 2020-02, Vol.41 (2), p.146-153
• Main Authors: Kessler, Jeffrey, Bjorklund, Pamela
• Format: Article
• Language: English
• Subjects: Adherence; Adult; Aged; Computerized medical records; Discharge; Drugs; Female; Humans; Male; Medical records; Medication Adherence - statistics & numerical data; Mental Disorders - drug therapy; Mental Disorders - psychology; Middle Aged; Nursing; Patient compliance; Patient Education as Topic; Patient participation; Patient Readmission; Practice Patterns, Nurses; Psychotropic drugs; Psychotropic Drugs - therapeutic use; Quality Improvement; Quality management; Readmission; Recidivism; Recidivism - statistics & numerical data; Recidivists; Risk factors; Self Care; Teaching; Veterans
• ISSN: 0161-2840; 1096-4673
• DOI: 10.1080/01612840.2019.1636907

This quality improvement (QI) project analyzed the impact of RN-led medication teaching on readmissions of adult patients discharged from a Midwest psychiatric veterans' hospital. Data on patient participation in the initiative, outpatient medication adherence, and annual 30-day readmission rates were gathered from electronic medical records (EMR) and patient discharge logs from years 2017 and 2018. Forty-three percent of RNs engaged in the initiative. Percentages of patients, who received medication teaching throughout the year, ranged from 27% to 40%. However, self-reported medication adherence following discharge was much higher (73-85%). The RN-led medication teaching initiative did not impact recidivism, and low staff participation was reflected by the downtrend in numbers of patients who received medication teaching throughout the year. Compared to previous years, annual recidivism increased. Fifty-three percent of recidivist patients who received medication teaching reported complete outpatient medication adherence prior to readmission, possibly indicating it is not a significant factor in preventing readmissions or, alternatively, that patients tend to over-report adherence. A small group of patients (19%) accounted for the majority of readmissions annually (70%). This group appears to be most at risk for continued recidivism. Future attempts to improve unit recidivism might benefit from aligning interventional strategies to the common risk factors of chronic recidivists.