Implementation of a Medication Management Evidence-Based Practice in a Public Sector Mental Health Treatment Setting

Monday, 22 July 2013

Peggy El-Mallakh, PhD, RN1
Patricia B. Howard, PhD, RN, FAAN2
Mary Kay Rayens, PhD2
Autumn P. Roque, BSN3
(1)College of Nursing, University of Kentucky College of Nursing, Lexington, KY
(2)College of Nursing, University of Kentucky, Lexington, KY
(3)College of Nursing, University of Kentucky, Lexington, VA

Learning Objective 1: The learner will be able to describe elements that contribute to organizational support for evidence-based practice implementation in a mental health treatment setting.

Learning Objective 2: The learner will identify facilitators and barriers to evidence-based practice implementation, and describe recommendations to improve implementation, in a mental health treatment setting.

Purpose: Present findings from an evidence-based practice implementation project on organizational support, barriers, and facilitators to implementation.  

Methods: This 3-year study used a mixed qualitative and quantitative design to test the feasibility of implementing a medication management EBP, the Medication Management Approaches in Psychiatry (MedMAP), in the treatment of schizophrenia in six Medicaid-financed community mental health clinics in a south-central state of the US. A 17-item Organizational Fidelity Scale was used to collect data on organizational support for MedMAP implementation at the participating clinical sites.    Qualitative data were obtained during in-depth interviews with 14 stakeholders in the MedMAP implementation study. Quantitative data analysis was conducted using means and standard deviations of organizational fidelity scores.  Qualitative data were analyzed using content analysis to identify relevant themes on barriers and facilitators of MedMAP implementation.

Results: Organizational support for MedMAP implementation was moderate. Support was highest for prescriber access to patient information and scheduling flexibility for urgent patient problems. Support was lowest for medication availability and identification of treatment-refractory patients. Facilitators to implementation included clinician awareness of the benefits of MedMAP in the provision of clinical care, communication between stakeholders, and feedback on fidelity ratings. Barriers to implementation included MedMAP requirements that were inconsistent with work flow, inadequate computer-based resources, organizational culture, payer source restrictions on reimbursement for several elements of MedMAP, and mandated restrictions from the state mental health regulatory agency related to medications included in the formulary.  

Conclusion: EBP implementation can be improved through nursing leadership at multiple levels within a service delivery organization, a paradigm shift in academic and clinical settings to support the use of EBPs, and development of innovative care delivery models. Nurses need to develop leadership, policy, patient advocacy, and information technology skills to promote optimal implementation of EBPs in their practice setting.