The Application of Data to Problem-Solving Psychiatric Hospital

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NURS-6051N The Application of Data to Problem-Solving

6051 Module 1, Week 1 Main Discussion Post

I work in a Psychiatric Hospital in Minnesota where we care for adults who have been committed mentally ill and dangerous. These patients have severe mental illness and their treatment is long and complex. However, one of the primary barriers to success we observe both while a patient is being treated in the facility and even to their continued success after they leave the facility is adherence to their medication regimen. Patients who take prescribed medications as directed and as consistently as possible are the most likely to succeed. However, this is all anecdotal experience. In my scenario, data could be collected to see how strong the correlation between medication adherence and successful treatment, as well as how interventions after discharge like the use of telemedicine or economic incentives could increase the likelihood of continued success. NURS-6051N The Application of Data to Problem-Solving

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There is strong statistical evidence to indicate that one of the primary barriers to successful medication adherence after discharge is an inability to gain access to continued psychiatric care easily and with minimal cost (Schulze, 2019). Work could be done at discharge to use local resources for telemedicine to help individuals as they work towards community integration. Data could be collected on medication adherence while receiving telemedicine services for psychiatric care to see if the continued access to remote care at minimal cost was effective in extended success after discharge without re-hospitalization. The nurse leader could use this information to help with current and future discharge planning, as a tool to ensure continued success.

Guinart offered up an interesting alternative to increasing the likelihood on ongoing medication adherence, in which participants can receive financial remuneration for taking scheduled injectable anti-psychotics (2019). While in the current political climate I believe such an intervention would be difficult to implement in a large scale, I believe it could be implemented on a smaller scale as a proof of concept. Guinart did find there was a statistically significant increase in medication adherence for patients with severe mental illness who were taking injectable anti-psychotics by giving them small financial incentive to take the medications as scheduled (2019). The nurse leader could use data obtained from this sort of small scale proof of concept as a localized alternative to help with the treatment of individuals with severe mental illness. I could envision the data could help a nurse design programs, with appropriate funding, to help local patients who have difficulty taking these medications consistently. The data could be presented to local government and healthcare officials to obtain funding in areas where these patients live. NURS-6051N The Application of Data to Problem-Solving

References

Guinart, D., & Kane, J. M. (2019). Use of behavioral economics to improve medication adherence in severe mental illness. Psychiatric Services, 70(10), 955–957. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ps.201900116

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Schulze, L. N., Stentzel, U., Leipert, J., Schulte, J., Langosch, J., Freyberger, H. J., Hoffmann, W., Grabe, H. J., & van den Berg, N. (2019). Improving medication adherence with telemedicine for adults with severe mental illness. Psychiatric Services, 70(3), 225–228. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ps.201800286

response 1

Advocation for using long-acting injectables (LAI) is the cornerstone of my nurse/patient teaching for my bipolar and schizophrenic patients. Our Crisis Unit here in Trenton, New Jersey, is the one that performs their involuntary commitment to inpatient hospitals. As a Crisis Screener (and psychiatric RN), I refer clients for commitment to our doctors. Many decompensate because they stop taking their medications. We know the use of drugs to treat bipolar/schizophrenia, especially LAIs, reduces the severity of severe mental illness and improves patient outcomes (U.S. National Library of Medicine National Institutes of Health, 2017). We know they stop because of poor insight towards their condition, dislike of medications (side effects such as impotence), low therapeutic alliance, and stigma (U.S. National Library).

A lecture I attended a few years ago given by a Pharm-D, said he found one of the most important variables to get patients to take their medications is if they trust their nurse. Trust makes perfect sense. Bipolar/schizophrenic patients are more compliant with medications if they have family support. They trust their relatives and are reminded to do so (remember their lack of insight). Without help, in my opinion, the use of LAIs to ensure they comply is the best choice to ensure better patient outcomes.

Question: Once your mentally ill patients are stable, taking their medications, and are discharged home, we know statistically, they will stop their medications. How will data collected on your unit change patients who are discharged and left on their own? Is LAIs in your plan? Great post.

The U.S. National Library of Medicine National Institutes of Health, March 3, 2017, Dawn I. Velligan et al. “Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for non-adherence to medication in patients with serious mental illness”, DOI: 10.2147/PPA.S124658.

response

Very informative post. I, too, work in psych and witness to issues of noncompliance to prescribed antipsychotics. Noncompliance negatively impacts the recovery journey. Nonadherence with prescribed medication regimens for psychiatric illnesses presents significant challenges. Sometimes it could be something as simple as the patient not having the wherewithal to transport themselves to refill their medication, thus preventing the patient from realizing all the benefits of their treatment and negatively impacting individuals, families, healthcare systems, and society. Therefore, Understanding and reducing nonadherence is a significant challenge to quality care for patients with psychiatric illness. Viala, Cornic, and Vacheron (2012) assert that utilizing antipsychotic injectables as initial treatment can reduce the relapse rate. Regarding financial remuneration for taking scheduled injectable antipsychotics as posited in the discussion. I found that even as Guinart and Kane (2019), made a case to alternatively increase the likelihood of medication adherence where patients may receive financial inducements to comply with scheduled injectable antipsychotics, Guinart and Kane (2020) also contend that offering financial incentives to patients especially those who are in need presents substantial ethical challenges. Thanks. NURS-6051N The Application of Data to Problem-Solving

References

Annie Viala, Françoise Cornic, & Marie-Noëlle Vacheron. (2012). Treatment Adherence with Early Prescription of Long-Acting Injectable Antipsychotics in Recent-Onset Schizophrenia. Schizophrenia Research and Treatment, 2012. https://doi-org.ezp.waldenulibrary.org/10.1155/2012/368687

resposne

You bring up some great points on using data relating to medication adherence for discharged psychiatric patients. How often a patient refills their medication can be measured with the help of the pharmacy. Insurance companies have monitored the frequency of refills to help determine medication compliance when I worked as a county case manager. It was my job to follow up with the data they provided me in order to help to increase compliance. In a study looking at medication adherence in 89 psychiatric patients, it was concluded that monitoring medication refills using the date the prescription was supplied may provide valuable information to a patient’s symptoms and functioning (Ermes et al., 2018). NURS-6051N The Application of Data to Problem-Solving

Providing a financial incentive to be compliant with monthly injections for psychiatric patients is brilliant. One study found financial incentives to be effective in improving adherence to psychiatric medications (Noordraven et al., 2018). From what I have seen working for the county, the patient population I assisted was in the very low-income bracket, therefore a financial incentive would not only work for this population but also provide many benefits. The benefits would include increased medication adherence with the goal of reduced healthcare costs by having their mental health symptoms controlled, resulting in a decrease in inpatient stays and Emergency Department visits. Though money is being spent upfront as an incentive, one may surmise that insurance companies would save money in the long-run due to the previously mentioned reasons.

Joy

References

Ermes, M., Vuorinen, A. L., Schrader, G., & Bidargaddi, N. (2018). Correlation between symptoms and functioning in psychiatric patients and temporal patterns of medication refills derived from pharmacy prescription claims. Australasian Psychiatry, 26(6), 643–647. Retrieved September 3, 2020, from https://doi.org/10.1177/1039856218781019 NURS-6051N The Application of Data to Problem-Solving

Noordraven, E. L., Wierdsma, A. I., Blanken, P., Bloemendaal, A., & Mulder, C. L. (2018). Medical and social costs after using financial incentives to improve medication adherence: results of a 1 year randomised controlled trial. BMC Research Notes, 11(1), 655. Retrieved September 3, 2020, from https://doi.org/ezp.waldenulibrary.org/10.1186/s13104-018-3747-1

Discussion: The Application of Data to Problem-Solving
In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge. NURS-6051N The Application of Data to Problem-Solving

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In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

Reflect on the concepts of informatics and knowledge work as presented in the Resources.
Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
By Day 3 of Week 1
Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

By Day 6 of Week 1
Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles. NURS-6051N The Application of Data to Problem-Solving

The use of information technology to organize and analyze health records to improve and impact healthcare outcomes positively is the very essence of healthcare informatics. According to Sweeney (2017), healthcare Informatics is “the integration of healthcare sciences, computer sciences, information science, and cognitive science to assist management of healthcare information” The collection of information, data, management and use of same is nothing new and has been in use for years by nurses and others. At the most basic level, nurses utilize healthcare informatics/technology daily (vital sign equipment) to deliver good patient care. Data is assessed continuously and utilized in nursing, and as McGonigle and Mastrian (2018), assert that nursing is an information-intensive profession and relies heavily on the use of healthcare informatics.

At my place employment (inpatient psychiatry), I have been tasked with collecting data to evaluate an increase in physical restraint use to manage patients who are assaultive or are a danger to themselves. For this assignment, I have access to the Electronic Health Records (EHR) of patients restrained within a specific time frame of six months and have been given access to restraint documentation and logs. In order to complete this assignment, I would utilize the tools as mentioned above to collate data, evaluate and compare trends at other sister units to ascertain why there is an increase in the use of restraints in our unit before I can present the data to management to act on and ultimately impact and improve patient outcomes (McGonigle and Mastrian, 2018). NURS-6051N The Application of Data to Problem-Solving

A nurse leader would utilize clinical reasoning and judgment in combination with data garnered from the assessment and collection of data regarding the above scenario to determine the causative factor or factors leading to an increase in physical restraints and would implement change or changes that will impact patient care positively. Healthcare informatics impacts nursing, some most notable impacts are clinical, managerial, and policy implications (Sweeney, 2017). More staffing may be required; there may be a need to retrain and re-educate staff on the protocols of engaging with agitated and assaultive patients. In some cases, data collection is time-consuming and may take months to collect, sort, and organize. Consequently, data may be outdated and may not be relevant and thus not useful, thereby requiring another data collection process. Therefore, healthcare informatics will continue to evolve and adapt to be current and will remain useful. Healthcare Information Technology (HIT) is a critical element of the new medical toolbox (McBride and Tietze, 2018).

References

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice nurse: patient safety, quality, outcomes, and interprofessionalism. Springer Publishing Company.

McGonigle, D., & Mastrian, K. G. (Eds.). (2015). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1). NURS-6051N The Application of Data to Problem-Solving