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提高儿科患者遵循非典型抗精神病药物筛查指南的依从性:在综合社区心理健康环境中进行的一项质量改进项目。

Improving Adherence to Atypical Antipsychotic Agent Screening Guidelines in Pediatric Patients: A Quality Improvement Project Within an Integrated Community Mental Health Setting.

机构信息

1 Elishia L. Featherston, DNP, RN, CPNP-PC, PMHS, University of Texas Arlington, Arlington, TX, USA.

2 Sharolyn Dihigo, DNP, RN, CPNP-PC, University of Texas Arlington, Arlington, TX, USA.

出版信息

J Am Psychiatr Nurses Assoc. 2018 Jul/Aug;24(4):352-359. doi: 10.1177/1078390317752444. Epub 2018 Jan 22.

Abstract

BACKGROUND

Approximately 14% to 20% of children and adolescents have a mental health problem. Atypical antipsychotic agents are used to treat behavioral, emotional, and mental health problems in children and adolescents. A discrepancy between best practices and actual practices exists.

OBJECTIVE

The purpose of this quality improvement project was to increase adherence above baseline, through implementation of a checklist, to recommended screening guidelines in children, ages 4 to 18, prescribed atypical antipsychotic agents over 12 weeks. Design/Results: Aggregate comparison of the mean ranks of scores were tested with the Mann-Whitney U test, U = 1,087.5, n = n = 70, total N =140, p < .001. Variables of body mass index, blood pressure, waist circumference, fasting glucose, fasting lipids, personal history, and family history were observed and tested using the chi-square with Fisher's exact tests and are significant at or above 99% confidence level ( p < .01).

CONCLUSION

Educating mental health providers, child and adolescent psychiatrists, and psychiatric mental health nurse practitioners on recommended screening guidelines and implementing a checklist had a measurable effect on increasing adherence to the recommended screening guidelines in a community mental health setting.

摘要

背景

约 14%至 20%的儿童和青少年存在心理健康问题。非典型抗精神病药物被用于治疗儿童和青少年的行为、情绪和心理健康问题。最佳实践与实际实践之间存在差异。

目的

本质量改进项目的目的是通过实施检查表,在 12 周内增加对推荐的筛查指南的依从性,从而提高为服用非典型抗精神病药物的 4 至 18 岁儿童开出的推荐筛查指南的依从性。

设计/结果:采用曼-惠特尼 U 检验对总得分的平均秩次进行了汇总比较,U=1087.5,n=70,总 N=140,p<.001。使用卡方检验和 Fisher 确切概率法对体重指数、血压、腰围、空腹血糖、空腹血脂、个人史和家族史等变量进行了观察和测试,置信水平在 99%以上(p<.01)。

结论

在社区心理健康环境中,教育心理健康提供者、儿童和青少年精神病学家以及精神科心理健康护士从业者有关推荐的筛查指南,并实施检查表,对增加对推荐的筛查指南的依从性有明显的效果。

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