NURS FPX 4905 Assessment 2 Free Download Student Name Capella University NURSE-FPX-4905 A2 Professor Name Submission Date A Practicum Analysis: Healthcare Process Issue An adverse effect has become a serious healthcare issue – the lack of response to antidepressant medications – among adults who seek treatment at a Mayo Clinic location, which has an impact on depression management overall. Antidepressants have also been used successfully as a first-line treatment option in major depression; however, most of those taking antidepressants are unable to take and adhere to them. This poor adherence leads to lack of response to treatment, and to less overall improvement of symptoms. The non-adherence to antidepressants worsens depression symptomology, raises the risk of relapse and recurrence of depression, can avoid hospitalizations, and leads to increased health care costs. This paper will address the healthcare process question: why are antidepressants not being taken as prescribed by the doctor? The patient behaviors related to antidepressant adherence will be addressed, as well as the application of nurse-led education and follow-up for intervention. Description of the Practicum Site I am doing my practicum time at a community-based ambulatory health care facility. Mayo Clinic in the United States (US) provides services that involve the psychiatric evaluation of adults and the provision of psychotropic medications to adults with psychiatric disorders, particularly dementia patients. The clinic plays an important role in enhancing accessibility and aiding in long-term maintenance treatment by the systematic follow-up of chronic psychiatric conditions and treatment on an individual basis, according to the study reported. Directed at out-patient management, the clinic’s area of focus is regularly scheduled follow-up (not acute or emergent). The patient population is generally 25+ years old and are typically diagnosed with major depressive disorder (MDD), are prescribed an antidepressant to help manage their MDD, receive periodic follow up with MDD for routine follow up. The majority of patients require full nursing care, rehabilitation, and drugs, as well as help in carrying out their daily activities and behavioral issues caused by dementia. On a subsequent appointment, the MDD checks on medication, signs of depression, Medication compliance, side effects, and effectiveness of treatment so far and provides therapeutic assistance if necessary. The facility has roughly 350 full-time healthcare workers: a psychiatrist, a psychiatric nurse practitioner, a registered nurse, a medical assistant, a behavioral health counselor, as well as administrative support. These providers are more likely to launch a multi-disciplinary approach to deliver the best, client-centered, evidence-based behavioral health care to aid depression management and ensure continuity of care for individuals prescribed an antidepressant. Clinical and Operational Decisions at the Practicum Site In my setting, the clinical and operational interventions I was interested in improving for adherence to antidepressants were aimed at: quickening the initiation of antidepressants, maintaining adherence, and decreasing attrition. Identifying patients who were not taking their medications, giving follow-up education and medication adherence assessments to each patient based on their individual problems, scheduling weekly contact with high-risk patients with my nurse preceptor, and documenting the medication adherence assessments and my nursing interventions in the EHR down to patients’ concerns for changes in the treatment plan as needed, were all included in clinical decisions made Basis for prescribing was the psychiatric prescriber’s, but I also contributed in supporting the clinical decision making as part of my clinical assessment and documentation. This has been supported in previous research, which found that having more follow-up visits (including nurse-led) and having work done as a team with other professionals was shown to improve adherence to taking medication, quality of care, fewer hospitalizations, and better management of depression that resulted in better depression outcomes (fewer relapses and improved quality of life). The severity of depression was determined by the Patient Health Questionnaire-9 (PHQ-9), and adherence to medication was a key quality indicator of this patient population. The clinical decision-making and outcomes were consistent with safe and evidence-based decisions that will likely lead to better depression management in the long run in this facility. Antidepressant Non-Adherence and Patient Outcomes The problem with which I have worked at the Practicum site involves a failure of adult outpatient clients who are depressed to take antidepressants. Many adults taking a prescribed antidepressant or serotonin-norepinephrine reuptake inhibitor (SNRI) may not be able to take their medication as directed as a group, which negatively impacts the effectiveness of their medication, symptom severity, and risk of relapse or hospitalization. This issue would be suitable for an intervention by Nurse-led Quality improvement. The interventions include a registered nurse (RN) to screen for medication adherence, patient teaching, and a weekly telephone call visit with an RN to document in the EHR and ongoing work with the interdisciplinary team. Presently, it has been noticed that the population generally fails to adhere to the treatment with antidepressants. Unni found that 42.9% and 46.2% of the population, in the USA and five European countries, respectively, were non-adherent. Their study concluded that the more common reasons cited for non-adherence were forgetfulness and concerns about medications. In a similar study, Chanie found another non-adherence rate of 32.9% among adults with depression, and listed the major factors associated with low adherence, such as being a woman, having low education levels, not working, length of treatment, and having severe side effects of the treatment. Lack of adherence also was found to be negatively associated with increased health care costs, relapse rate, emergency room visits, and hospitalizations, Gutirrez-Abejn also found. Results support the need for an interdisciplinary approach with a nurse-led intervention to enhance adherence to medications. Analysis of Impact on Quality, Safety, and Cost When patients are not taking their antidepressant medication, it is detrimental not only to the patient’s treatment, but also to the healthcare system. Failure to take medication (or adhere to a treatment regimen) was a factor that led to treatment failure, slowed drug healing, and lowered rates of drug remission; ultimately affecting the quality of care and drug outcomes. It was revealed that poor adherence to depression medication leads to poor depression outcomes, in
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