Degree Name
Nursing Practice, DNP
Publication Date
4-26-2026
First Advisor
Sandy King
Second Advisor
Beatrice Bailey
Abstract
Schizophrenia is a chronic psychiatric disorder associated with relapse, hospitalization, and poor outcomes when medication adherence is suboptimal. Nonadherence increases morbidity and healthcare utilization (World Health Organization, 2022; Zhao et al., 2025). Long-acting injectable (LAI) antipsychotics improve adherence and reduce hospitalization, but inconsistent monitoring and documentation in outpatient settings hinder early identification of missed doses (Lieslehto et al., 2022). This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate whether staff education and structured refill-monitoring processes improve identification and documentation of nonadherence to LAI antipsychotics. Using Kotter’s Change Management Model and the Plan-Do-Study-Act framework, the project focused on workflow and clinician behavior change (Abuzied et al., 2023). A pre–post intervention design was used in an outpatient mental health clinic. The intervention included staff education, standardized documentation tools, and review of pharmacy refill histories over six weeks. Data were collected through chart audits and the Mental Illness Clinicians’ Attitudes (MICA) scale. Documentation of missed LAI doses improved from 20% (n = 4/20) pre-intervention to 58.3% (n = 7/12) post-intervention (p = .028). Clinician attitudes also improved, with median MICA scores decreasing from 66 to 49 (p = .011). Findings show that structured interventions enhance adherence monitoring and support early identification of nonadherence (Aprile et al., 2025; Carmassi et al., 2021; Kane et al., 2020). This project advances practice by improving documentation workflows and clinician attitudes.
Rights Management
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Bruce, Stacy Ann, "Improving Monitoring and Documentation of Long-Acting Injectable Antipsychotic Adherence in Patients with Schizophrenia Through Staff Education and Refill History Review" (2026). Doctor of Nursing Practice Projects. 335.
https://arch.astate.edu/dnp-projects/335
