Improving the clinical monitoring of extrapyramidal symptoms: a local quality improvement project.
Antipsychotics
Clinical audit
Extrapyramidal symptoms
Quality improvement
Journal
Irish journal of medical science
ISSN: 1863-4362
Titre abrégé: Ir J Med Sci
Pays: Ireland
ID NLM: 7806864
Informations de publication
Date de publication:
08 Oct 2023
08 Oct 2023
Historique:
received:
27
06
2023
accepted:
26
09
2023
medline:
8
10
2023
pubmed:
8
10
2023
entrez:
8
10
2023
Statut:
aheadofprint
Résumé
Extrapyramidal symptoms (EPS) can cause significant morbidity and impact negatively on patients' quality of life. Clinical guidelines provide recommendations regarding screening frequency and the use of structured tools to ensure adequate monitoring of EPS. Despite this, the literature indicates that the documentation and monitoring of EPS remain suboptimal. To devise an intervention that would lead to the improvement in the documentation and hence monitoring of EPS. An initial paper chart survey was conducted to assess the current extent of documentation and monitoring of EPS carried out in patient files of three distinct settings in our Mental Health Service (MHS): inpatient, rehabilitation, and assertive outreach. An intervention aimed at improving practice was subsequently designed and implemented. This involved adoption by the MHS of a new EPS monitoring tool and delivery of an educational session regarding its use. The extent of documentation and monitoring of EPS was re-surveyed post-intervention. Initially, only 14.8% of inpatient records contained evidence of EPS documentation while no evidence at all was found across the other two MHS settings. Following the intervention, there was evidence of guideline concordant EPS monitoring using a structured tool in the clinical records of 75% of inpatients, 79.6% in the rehabilitation setting, and 18% in the assertive outreach programme. Documentation of EPS monitoring improved significantly across several settings affiliated with a Dublin North City MHS following the systematic adoption of the Extrapyramidal Symptom Scale (EPSS) and clinician education regarding its use.
Sections du résumé
BACKGROUND
BACKGROUND
Extrapyramidal symptoms (EPS) can cause significant morbidity and impact negatively on patients' quality of life. Clinical guidelines provide recommendations regarding screening frequency and the use of structured tools to ensure adequate monitoring of EPS. Despite this, the literature indicates that the documentation and monitoring of EPS remain suboptimal.
AIMS
OBJECTIVE
To devise an intervention that would lead to the improvement in the documentation and hence monitoring of EPS.
METHODS
METHODS
An initial paper chart survey was conducted to assess the current extent of documentation and monitoring of EPS carried out in patient files of three distinct settings in our Mental Health Service (MHS): inpatient, rehabilitation, and assertive outreach. An intervention aimed at improving practice was subsequently designed and implemented. This involved adoption by the MHS of a new EPS monitoring tool and delivery of an educational session regarding its use. The extent of documentation and monitoring of EPS was re-surveyed post-intervention.
RESULTS
RESULTS
Initially, only 14.8% of inpatient records contained evidence of EPS documentation while no evidence at all was found across the other two MHS settings. Following the intervention, there was evidence of guideline concordant EPS monitoring using a structured tool in the clinical records of 75% of inpatients, 79.6% in the rehabilitation setting, and 18% in the assertive outreach programme.
CONCLUSION
CONCLUSIONS
Documentation of EPS monitoring improved significantly across several settings affiliated with a Dublin North City MHS following the systematic adoption of the Extrapyramidal Symptom Scale (EPSS) and clinician education regarding its use.
Identifiants
pubmed: 37805958
doi: 10.1007/s11845-023-03539-8
pii: 10.1007/s11845-023-03539-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.
Références
Schouten HJ, Knol W, Egberts TC et al (2012) Quality of life of elderly patients with antipsychotic-induced parkinsonism: a cross-sectional study. J Am Med Dir Assoc 13(1):82.e1–5. https://doi.org/10.1016/j.jamda.2010.12.003
Ayehu M, Shibre T, Milkias B et al (2014) Movement disorders in neuroleptic-naïve patients with schizophrenia spectrum disorders. BMC Psychiatry 14:280. https://doi.org/10.1186/s12888-014-0280-1
McCreadie RG, Srinivasan TN, Padmavati R et al (2005) Extrapyramidal symptoms in unmedicated schizophrenia. J Psychiatr Res 39(3):261–266. https://doi.org/10.1016/j.jpsychires.2004.08.002
Salahudeen MS, Duffull SB, Nishtala PS (2015) Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr 15:31. https://doi.org/10.1186/s12877-015-0029-9
Ward KM, Citrome L (2018) Antipsychotic-related movement disorders: drug-induced parkinsonism vs. tardive dyskinesia—key differences in pathophysiology and clinical management. Neurol Ther 7(2):233–248. https://doi.org/10.1007/s40120-018-0105-0
Keepers GA, Fochtmann LJ, Anzia JM et al (2020) The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 177(9):868–872. https://doi.org/10.1176/appi.ajp.2020.177901
National Institute for Health and Care Excellence (NICE) (2014) Psychosis and schizophrenia in adults, treatment and management, Clinical Guideline No. 178. https://www.nice.org.uk/guidance/cg178/chapter/recommendations . Accessed 15 Mar 2021
Cortese L, Jog M, McAuley TJ et al (2004) Assessing and monitoring antipsychotic-induced movement disorders in hospitalized patients: a cautionary study. Can J Psychiatry 49(1):31–36. https://doi.org/10.1177/070674370404900105
Dixon L, Weiden PJ, Frances AJ et al (1989) Management of neuroleptic-induced movement disorders: effects of physician training. Am J Psychiatry 146(1):104–106. https://doi.org/10.1176/ajp.146.1.104
Kuruvilla K, Sedano-Ruiz JA, Ley A (2006) Drug-related movement disorders: training experiences of psychiatrists. Psychiatric Bull 30(8):300–303. https://doi.org/10.1192/pb.30.8.300
doi: 10.1192/pb.30.8.300
Butler MI, Chandrakanth J (2016) Monitoring of extrapyramidal side effects in patients on antipsychotic treatment: a completed audit cycle. Ir J Psychol Med 33(3):165–169. https://doi.org/10.1017/ipm.2015.27
Pringsheim T, Barnes TR (2018) Antipsychotic drug-induced movement disorders: a forgotten problem? Can J Psychiatry 63(11):717–718. https://doi.org/10.1177/0706743718786702
Caroff SN (2019) Overcoming barriers to effective management of tardive dyskinesia. Neuropsychiatr Dis Treat 15:785–794. https://doi.org/10.2147/NDT.S196541
Hastings T, Tibbo P, Williams R (2022) Extrapyramidal Rating Scale (EPSS). Canadian Consortium for Early Intervention in Psychosis. https://www.epicanada.org/epss . Accessed 4 Oct 2022
Langley GJ, Moen RD, Nolan KM et al (2009) The improvement guide: a practical approach to enhancing organizational performance. John Wiley & Sons