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*230. The Role of Psychiatric Nursing and Medication Adherence

JK Kemppainen, VA Palo Alto Health Care System, Palo Alto, CA; M Buffum, VA San Francisco, San Francisco, CA; G Wike, BA Central California Health Care System, Fresno, CA; M Kestner, VA Honolulu, Honolulu, Hawaii; C Zappe, VA Sierra Nevada Health Care System, Reno, NV; R Zind, VA Central California Health Care System, Sacramento, CA

Objectives: While anecdotal evidence suggests that nurses play an important role in contributing to positive patient outcomes in psychiatric treatment settings, surprisingly little research has focused on their contribution to facilitating adherence to psychiatric medication regimens. The members of the Sierra Pacific Nursing Research Consortium completed a VISN-wide survey aimed at identifying work activities used by psychiatric nurses to monitor and encourage medication adherence in their patients. Study objectives included: 1) identifying strategies for tracking and facilitating adherence to antipsychotic medication regimens, and 2) describing psychiatric nursesí role perceptions concerning medication adherence.

Methods: A 10-item open-ended survey was designed specifically for this study. The survey was pilot tested and minor modifications were made, based on feedback from the participants. Study coordinators at 6 sites in VISN 21 facilitated distribution of the surveys to psychiatric nurses in all inpatient settings and outpatient clinics and treatment programs. Participant sites included: 1) VA Central California Health Care System in Fresno, CA, 2) Honolulu VAMC, 3) VA Palo Alto Health Care System, 4) VA Sierra Nevada Health Care System in Reno, NV., 5) Northern California Health Care System, and 6) San Francisco VAMC.

All narrative answers from the survey were entered into a large Microsoft Word data file, organized by survey item. Response frequencies were tabulated for each item, based on inpatient and outpatient work settings. Data analysis was completed by an expert review panel that included the members of the research team and three psychiatric nurse experts.

Results: The overall survey response rate was 60%. The sample included 126 psychiatric nurses (20 males and 106 females) with an average age of 50 years (SD 9.3 yrs.), and an average length of experience in psychiatric nursing of 17 years (SD 9.9 years). Participants included staff nurses (n=74, 59%), advanced practice nurses (n=42, 33%), and nurse managers (n=10, 8%). Practice settings included inpatient (n=67, 56%), outpatient (n=26, 22%), general medical clinics (n=7, 6%), day treatment centers (n=5, 4%), and community care programs (n=4, 3%). Nurses use a wide variety of creative strategies to track adherence. Outpatient nurses determine adherence directly through clinical presentation and patient self-reports, and indirectly through computer tracking of prescription refills, compliance with appointments, and monitoring blood levels. Inpatient nurses monitor adherence during medication administration, and also through direct observation of behavior and mental status. Strategies aimed at encouraging adherence include the use of pill boxes, dose calendars, reminder signs, supervising patient "self pouring," and pill counts. The issue of trust in the nurse-patient relationship was identified as a key factor in facilitating medication adherence by the majority of the nurses.

Conclusions: VA nurses play a significant role in tracking and encouraging medication adherence in psychiatric treatment settings, and assign a high priority to this patient outcome.

Impact: This study represents an initial effort to identify and categorize specific nursing activities related to medication adherence in psychiatric patients. Study findings provide important direction for future work aimed at testing the impact of nursing adherence interventions on increased patient compliance.