VA-ANTIPSYCHOTIC MED SIDE EFF EVAL (177)    REMINDER DEFINITION (811.9)

• EDIT DATE:   2005-03-11 12:20:51
  EDIT BY:   USER,ONE
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Prolonged use of antipsychotic medications can result in abnormal 
taking antipsychotic medications. The biggest challenge in defining this 
reminder is the identification of the cohort of patients to whom it is 
applicable. The pharmacy database structure does not make it easy to 
identify patients who have been on antipsychotics for a prolonged period 
of time. Even if it did, there are some patients who have not received 
antipsychotics from VHA for an extended period but who have been 
receiving these medications for a long time from non-VHA sources or who 
are receiving depot neuroleptics from ward stock (not recorded in the 
pharmacy files.). If the cohort were defined simply as any patients
currently on an antipsychotic, it would be applicable to patients who have
involuntary movement disorders, which can be managed by changing 
been on an antipsychotic for a very brief period of time. The solution to
the cohort problem taken by the proposed reminder is to limit the
applicability of the reminder to patients on specific antipsychotic
drug classes which do not include those medications commonly used as 
antiemetics.
 
Sites should ensure that the AIMS reminder does not appear for clinicians 
who are not responsible for the management of antipsychotic medication 
side effects. This can be accomplished by using the CPRS cover sheet 
parameters to display the reminder only to those users who evaluate the 
medications, altering the dose of a medication, or prescribing 
patients for side effects of antipsychotics.
 
The proposed reminder could be resolved in one of three ways: (1) by 
administering the AIMS, (2) by indicating that the patient was 
non-compliant with the prescribed medication, or (3) by indicating the 
patient refused the evaluation. Clinician narrative documentation of 
motor control is not sufficient.
 
This national reminder contains reminder terms for the positive and 
negative evaluation for abnormal involuntary movements. If sites use a 
medications to control the movement disorder symptoms. Thus, the 
local health factor or exam or use the Simpson-Angus and record the 
results as a health factor, then those sites will need to map the 
findings to the terms and add appropriate entries to the dialog to match:
 
  AIM EVALUATION NEGATIVE 
  AIM EVALUATION POSITIVE
 
The only findings in these reminder terms that are exported are the 
results of the AIMS from the Mental Health package.
 
Psychoses Clinical Practice Guideline recommends an evaluation of 
The reminder term ANTIPSYCHOTIC MEDICATIONS contains the drug classes 
CN701 and CN709.  In addition, a health factor is included in this term
for use in recording that the patient is on a depot antipsychotic that is
being administered in clinic from ward stock. If the medication is not
dispensed from the pharmacy, then no data is available to the reminder to
determine that the patient is on an antipsychotic unless this health
factor is used.  This health factor for depot neuroleptics can be placed 
on an encounter form or into a reminder dialog for injections.
movement disorder symptoms annually for patients on antipsychotic 
medications using either the Abnormal Involuntary Movement Scale (AIMS) 
or the Simpson-Angus. The proposed reminder would prompt clinicians to 
complete an evaluation of movement disorders once a year on patients 

• FINDING ITEM:   VA-SCHIZOPHRENIA DIAGNOSIS
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  The patient has a diagnosis of schizophrenia.
  

  BEGINNING DATE/TIME:   T-1Y
• FINDING ITEM:   VA-ANTIPSYCHOTIC DRUGS
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  USE IN PATIENT COHORT LOGIC:   AND
  BEGINNING DATE/TIME:   T-30D
• FINDING ITEM:   VA-AIM EVALUATION NEGATIVE
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  USE IN RESOLUTION LOGIC:   OR
• FINDING ITEM:   VA-AIM EVALUATION POSITIVE
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  USE IN RESOLUTION LOGIC:   OR
• FINDING ITEM:   VA-REFUSED AIM EVALUATION
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  USE IN RESOLUTION LOGIC:   OR
  BEGINNING DATE/TIME:   T-3M
• FINDING ITEM:   VA-REFUSED ANTIPSYCHOTICS
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  USE IN PATIENT COHORT LOGIC:   AND NOT
  BEGINNING DATE/TIME:   T-30D

The reminder terms for this reminder are:
        from ward stock and the drug classes CN701 AND CN709.
 
     REFUSED AIM EVALUATION
        Includes a health factor for refusal of evaluation.  Used in 
        resolution logic to resolve the reminder for 3 months.
 
     REFUSED ANTIPSYCHOTICS
        Includes health factor for refusal to take medications.  This 
        finding excludes the patient from the cohort for 1 month.  
 
     AIM EVALUATION NEGATIVE
     SCHIZOPHRENIA DIAGNOSIS
        This term includes the taxonomy for schizophrenia (295.00 - 
        295.95).
 
The reminder is due if the patient is on medication (RT:ANTIPSYCHOTIC
DRUGS).  The finding for the reminder term for the drugs has an effective
period of 30 days. (This means that the reminder will show as due for the 
time period that the patient has an active supply of drug based on last 
release date plus the days' supply and for an additional 30 days.) The
health factor of DEPOT NEUROLEPTIC has an effective period of 60 days.
        Includes AIMS<=6 as indicated by a score in the MH package.
 
     AIM EVALUATION POSITIVE
        Includes AIMS>=7 as indicated by a score in the MH package.
 
     ANTIPSYCHOTIC DRUGS
        Includes a health factor for administration of depot neuroleptics

• URL:   http://www.oqp.domain.ext/cpg/cpg.htm
  WEB SITE TITLE:   CPG Website

Patients on long-term antipsychotics should have an evaluation for side 
effects by administration of a test for abnormal involuntary movements on 
at least a yearly basis.

• REMINDER FREQUENCY:   1Y
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