Improving Clinician Adherence Rates to AIMS Testing on Individuals Taking Long-Term Antipsychotics

Problem: Tardive dyskinesia is a common problem that creates challenges in the lives of those affected by it. The Abnormal Involuntary Movement Scale records the occurrence of tardive dyskinesia in patients receiving neuroleptic medication. With this scale, clinicians can detect tardive dyskinesia and its severity over time. The aim of this study is to learn the current rate of adherence for clinicians at the organization and to create and implement an intervention that will increase that rate in an effort to improve patient outcomes and quality of life. Methods: This quality improvement project will use a descriptive cohort design. A retrospective and prospective medical record review will be used to determine pre-post education effectiveness for AIMS screening. Results: Of the 53 charts reviewed pre implementation, 62% had an AIMS screening, whereas post implementation 72% has an AIMS screening showing a 10% increase. Of those screened pre implementation, 6% had a positive AIMS scores compared to the 0% recorded post implementation. Discussion: The increase in AIMS screenings helped to identify early symptoms of Tardive Dyskinesia and enabled early treatment, especially for those who were at an increased risk including older African American men prescribed first generation antipsychotics. This project identified a need to increase the number of providers trained on AIMS screening in an effort to increase the adherence rates facility wide. IMPROVING CLINICIAN ADHERENCE RATES TO AIMS TESTING 3 Improving Clinician Adherence Rates to AIMS Testing on Individuals Taking LongTerm Antipsychotics Thousands of individuals are affected by tardive dyskinesia annually. It is estimated that 500,000 persons in the United States have been affected by tardive dyskinesia with about 60% to 70% of the cases being mild, and 3 percent extremely severe (Robert, 2019). Tardive dyskinesia is characterized by involuntary stereotyped, choreic, athetoid, and/or dystonic movements in one or more areas of the body, including the orofacial region, extremities, and torso (Kane, Correll, Nierenberg, Caroff, Sajatovic, 2018). The clinical presentation of tardive dyskinesia may include but are not limited to tongue thrusting, lip smacking and or pursing, grimacing, stereotypic piano-playing movements, flexion/extension of the ankles or toes and pelvic rocking (Citrome, 2017). Tardive dyskinesia is caused by taking prescription medications such as antipsychotic, tricyclic antidepressants, and antiemetics. However, exposure to dopamine receptor blocking agents such as antipsychotics place individuals at an increased risk for developing tardive dyskinesia. In patients taking antipsychotics, 20% to 25% develop tardive dyskinesia (Citrome, 2017). The Abnormal Involuntary Movement Scale (AIMS) (see Appendix A) is a rating scale that was designed in the 1970s to measure involuntary movements and is still widely used today (Brasic, 2018). The AIMS test has a total of 14 items rating involuntary movements of various areas of the patient's body. AIMS is used as an efficacy measure in clinical trials that focus on improvements in tardive dyskinesia. With this scale, clinicians can detect tardive dyskinesia and its severity over time. AIMS testing should be conducted every six months (Kane et al., 2018). However, Johnson IMPROVING CLINICIAN ADHERENCE RATES TO AIMS TESTING 4 (2017) and Brasic (2018) state, AIMS testing should be done upon initiation of a neuroleptic medication and then every three months thereafter. Implementation of routine AIMS testing should help to decrease hospital related cost, decrease the numbers of those affected by tardive dyskinesia, and improve patient outcomes. The purpose of this study is to increase clinician adherence to AIMS screening. The aim of this quality improvement project is to establish baseline of AIMS screening; disseminate data to the facility staff to improve adherence to AIMS screening in adult patients taking antipsychotic medications. Additionally, this project will provide education to providers on the current literature finding related to tardive dyskinesia including up to date recommendations and protocol for screening and treatment. The questions for this project is: 1. In patients 18 years old or greater, who are prescribed a neuroleptic medication in a Midwestern urban mental health outpatient setting, what is the effect of implementing AIMS screening? a) How many were screened using the AIMS scale before and after implementation? b) What is the rate of positive AIMS score before and after implementation? c) When there is a positive AIMS score; what percentage had a change made to the treatment plan before and after implementation? d) Was there a difference in results as it relates to demographic data, including age, race/ethnicity, neuroleptic medication type, and diagnoses before and after implementation? IMPROVING CLINICIAN ADHERENCE RATES TO AIMS TESTING 5 Review of Literature A review of literature was conducted through University of Missouri-St. Louis library databases including CINHAL, Public/Publisher MEDLINE (PubMed), and Psychological Information (PsycINFO) databases for relevant articles related to tardive dyskinesia in the population of patients taking antipsychotics. Searches for articles were conducted on these databases from 2015 to 2019.