NURS FPX 9000 Assessment 3 Topic Report With CITI Training

Student name

Capella University

NURS-FPX9000

Professor name

Submission Date

Topic Report with CITI Training

The topic summarizes the doctoral project aimed at enhancing timely diagnosis and reporting of tardive dyskinesia (TD) in adults undergoing long-term antipsychotics in an outpatient psychiatric clinic. The report outlines the gap in the current practice identified, suggests the evidence-based interventions based on the standardized screening of abnormal involuntary movement with the help of the abnormal involuntary movement screening (AIMS) scale, structured documentation, and follow-up procedures, and specifies the anticipated outcomes.

There is some evidence that intervention programs based on multicomponent screening and documentation provided by trained nursing personnel significantly improve the detection of TD and the early clinical management of the situation, resulting in better patient outcomes and quality care (Matthews, 2025). The institutional CITI program has been taken to satisfy all my ethical research training needs. The ethical practices related to human subjects protection are also met and reported in the CITI training transcript shown in the appendix to guarantee that ethical standards are adhered to in quality improvement efforts.

Project Problem and Relevant Evidence

The issue of the TD monitoring as a patient safety issue of concern is also a concern in the case of long-term antipsychotic therapy in adults. TD screening in the United States is not yet optimal, and studies show that less than 30 percent of psychiatric patients undergo the guideline-suggested AIMS assessments even when cumulative exposure of their health is at risk (Nedunjelian et al., 2025). The outpatient psychiatric clinic under consideration in Los Angeles County has around 80-120 adult patients each week, and almost 65-70 percent of them are prescribed the first- or second-generation antipsychotics (Nurse Manager, personal communication, November 9, 2025). According to baseline information available in the clinic, it is revealed that individuals with a documented AIMS assessment in the last 12 weeks constituted a mere 22 percent of the eligible patients (Nurse Manager, personal communication, November 9, 2025).

The determined standard is that AIMS screening should be conducted at baseline, and at least every 12 weeks to all adults undergoing antipsychotic treatment (American Psychiatric Association, 2025). In contrast to the discovered benchmark, the clinic has a 22-percent screening rate, which is a 58-percentage-point gap, which means that it violates evidence-based monitoring standards significantly (Nurse Manager, personal communication, November 9, 2025). Further testing indicates that only 9 percent of assessments filled in were fully scored and documented, and thus the progress of the symptoms could not be easily tracked (Nurse Manager, personal communication, November 9, 2025).

As it has always been proven, timely diagnosis of TD causes more progressive abnormal movements, lower adherence to treatment, dysfunction, and more long-term disability, and systematic intervention is inevitable (Griffiths et al., 2025). The existing approaches of the clinic are based on the will of providers, are not based on standardized screening schedules, and are characterized by heterogeneous ways of documentation, which leaves TD risks untreated and exposes patients to the risks of developing symptoms that cannot be avoided.

The baseline measures should also be carefully analyzed to make sure that the outcomes are evaluated correctly once the intervention is introduced. The existing practice in the clinic is chart audits on AIMS documentation in the electronic health record and narrative of side effects of movement by the provider, which are inconsistent in completeness and location. The main measure (percentage of antipsychotic-treated patients who have gone through complete screenings by AIMS) is used as the baseline measure of practice gaps. Other process measures consist of AIMS scoring completeness, following up actions on abnormal results, and new and progressive cases of TD (Matthews, 2025).

In outpatient settings, as opposed to inpatient settings, where there is a more structured workflow of assessment, the monitoring is mostly based on standardized tools that provide consistent assessment. Implementation of a systematic AIMS template and a specified 12-week screening procedure will enhance the measurement reliability, minimize the variation in documentation and enhance validity of TD monitoring. The optimal use of quality improvement activities and long-term maintenance of the practice change will be attained through systematic measurement of both process and outcome measures.

Evaluation of Metrics and Areas for Improvement

The measures will be assessed in terms of monitoring the proportion of patients under antipsychotics with undergone AIMS screenings, the accuracy of recording scores, and the adherence to follow-up measures on abnormal results. The measures will enable the clinic to establish whether the standardization of workflows enhances the rates of compliance with screening and the quality of documentation during the 12-week period.

The preliminary findings show the need to work on the issues, including the rate of compliance with the screening schedule among the staff, proper scoring, and the professional accuracy of the documentation in the electronic health record (Griffiths et al., 2025). The sustainability and continuous improvement of training, workflow design, and documentation templates will be directed by ongoing monitoring to assist in the long term.

The Project Site

The location of the project site is a private outpatient psychiatric clinic in Los Angeles County that serves a varied population of adults in an urban community setting. The clinic offers ambulatory-level psychiatric services, medication care, psychiatric assessments, psychotherapies, and telepsychiatric care to those with permanent and chronic mental illnesses who require long-term care. It is a small interdisciplinary organization comprising of psychiatric providers, nurses, and support staff that work in an outpatient setting without inpatient or emergency services. The clinic operates about 80-120 adult patients each week, and many of them are prescribed first- or second-generation antipsychotic drugs to treat schizophrenia, schizoaffective or bipolar disorder, or major depressive disorder with psychotic characteristics ( Nurse Manager, personal communication, November 9, 2025).

A significant percentage of the population will need regular checking on drug-induced movement disorders, which will give an ideal environment to implement a quality improvement project aimed at tardive dyskinesia screening and reporting. The outpatient model enables the use of regularly scheduled visits, so it is possible to introduce standardized AIMS screening protocols, organized documentation, and follow-up procedures across repeated patient visits. The size of the clinic, the volume of patients, and the service model all contribute to the high feasibility of implementation and evaluation of the project proposed.

Project Support at the Project Site

Proper working relations between project leaders and project stakeholders at the site are very important in facilitating successful quality improvement implementation and long-term sustainability. The outpatient psychiatric clinic has had robust project support, with administrative and clinical leaders being evidently committed to the project.

The preceptor is a board-registered psychiatric mental health nurse practitioner who has over 20 years of superior clinical practice experience in psychopharmacology, chronic management of mental illnesses, and coordination of outpatient care. The weekly meetings with the preceptor will help to continuously improve the tardive dyskinesia screening initiative to ensure constant amendment of the AIMS protocol, documentation process, and any possible workflow adjustments that might be necessary to effectively implement into the regular care patterns.

The preceptor gave permission to patient schedules, electronic health record functions, documentation templates and standardized clinic processes required to be applied in planned AIMS assessments during follow-up visits. Biweekly psychiatric provider, registered nurses, and front-office support personnel interact with stakeholders and the provider to receive formal feedback on the feasibility of the protocols and their compatibility with present job obligations. The following titles of the engaged stakeholders were used: psychiatric mental health nurse practitioner, staff psychiatrist, registered nurse, medical assistant, and clinic administrator.

Arguments revolving around time management when it comes to patient interaction, efficiency of documentation, when in the line of workflow to carry out the AIMS, and how to enhance screening consistency among all providers and not just a few. It has been demonstrated in recent literature that integrated organizational support and participation of experienced preceptors are major contributors to the successful implementation and maintenance of quality improvement interventions in outpatient psychiatric environments (Santos et al., 2022).

Feedback on the process noted that short, standardized processes were necessary that would be easily integrated into the medication-management appointments without adding to the visit time. Other issues that the stakeholders cited as challenges that would need specific planning were a lack of time to appoint, conflicting clinical needs, and inconsistent knowledge of movement-disorder assessment by the staff. The preceptor suggested the addition of short skills refresher, visual cue cards, and supportive communication strategies that would help to motivate the patient to participate in the screening process.

Areas for Preparation Enhancement

Further training on the accuracy of scoring AIMS among all clinical staff members would help to benefit from the enhanced preparation. It can be further advanced through the creation of a well-defined workflow algorithm to describe the screening tasks at any given one of stage during the visit to a patient (Matthews, 2025). Increased preparedness would also be achieved by increasing the orientation materials, such as quick-reference materials, that would strengthen similar assessment practices. Better preparation may be enhanced through short simulation training, which enables the employees to rehearse on screenings prior to the entire project implementation.

Proposed Interventions

The primary evidence-based intervention in the project is the introduction of routine and standardized use of the AIMS with all adult outpatients on the antipsychotic medications. The specified intervention implies the training of nursing and clinical personnel, the inclusion of AIMS in the electronic health record with a structured documentation template, and the planned AIMS assessment at the baseline with pre-established post-intervention measures in case of the detection of abnormal movements (American Psychiatric Association, 2025). An outpatient psychiatric clinic quality-improvement intervention involving a one-hour AIMS training session was associated with a 3 to 87 percent improvement in documentation rates before and after the intervention, respectively (Singh et al., 2013).

Other outpatient private-practice initiatives also reported increasing AIMS screening by 0% to 80% in a few weeks after the implementation (Mishra et al., 2024). In an inpatient environment, a TD screening service that is driven by pharmacists enhanced by 85.1% the number of AIMS screenings that high-risk patients tried to receive (Fagiolini et al., 2025). Lastly, a study showed that the early diagnosis of TD was made possible through systematic AIMS application, which led to subsequent consultations on the neuroleptic risk of treatment (Martino et al., 2023). The combination of the studies upholds the fact that standardized screening of tardive dyskinesia using AIMS with training, documentation, and follow-up procedures has a positive effect on the detection and reporting of new or progressive tardive dyskinesia in outpatient antipsychotic cohorts.

Educational Interventions

The quality improvement project educational intervention will consist of a rigorous training program among the nursing staff and other clinical personnel who will be dealing with patient care and patient monitoring at the outpatient psychiatric clinic. The target groups will consist of registered nurses, nurse practitioners, and medical assistants who are regularly dealing with patients under long-term antipsychotic treatment. Training will involve how to administer the AIMS correctly, good documentation habits through the use of electronic health record templates, detecting early symptoms of tardive dyskinesia, and setting up of follow-up mechanisms in case of abnormal movements. It will include training sessions in the form of short didactic presentations, demonstration videos, case scenarios, and practice, and the competency validation to guarantee that the staff understands and knows their competencies.

The mentioned educational intervention complements the primary project intervention due to its ability to provide reliable and consistent AIMS measures, standardize data documentation, and enhance adherence to standardized follow-up protocols, all of which enhance the ability to detect and track the symptoms of TD (Chakrabarty et al., 2023). The available evidence points to the fact that specific employee training improves the implementation following and promotes the early detection of movement disorders in outpatient psychiatric environments (Chakrabarty et al., 2023). The effective accomplishment of the educational intervention cycle will likely enable the staff, facilitate the use of checks and balances, and lead to a direct positive effect on patient safety and quality of care results.

Additional Information

Other data that might be necessary is the baseline staff levels of knowledge and competency in reference to AIMS administration and TD recognition. The information about the existing workflow performance and time spent on patient visits may assist in customizing the intervention so that it would cause the least disruption. Data on obstacles to regular documentation, including electronic health record issues or staffing factors, would be used to recommend the specific solutions (Chakrabarty et al., 2023). Patient feedback on their experience with movement assessments may also be used to further inform the strategies to improve engagement and adherence to follow-up protocols.

Comparisons

Meaningful improvements on quality improvement projects must be clear on how the current practice is compared to the desired evidence-based standard to determine improvements. The practices related to the TD monitoring at the outpatient psychiatric clinic are not consistent since the AIMS assessments are currently conducted not in a regular pattern, depending on the will of particular practitioners. Baseline information shows that a significant proportion of patients undergoing long-term antipsychotic treatment has recorded AIMS assessment, with only 22 percent and only 9 percent of the patients being fully scored and follow-up recorded.

The clinic has no systems or guidelines to direct regular evaluation, interpretation, and prompt intervention over new or progressive TD symptoms, and this has left a big gap compared to American Psychiatric Association (APA) guidelines that advise examination and at least 12-week dissemination of AIMS assessments.

It has been shown that structured screening and documentation interventions are far more effective in IDing TD and responding to it clinically than normal, unstructured practice (Jackson et al., 2021). The intended care status entails the systematic introduction of standardized AIMS screening, the structured electronic documentation models, and articulated follow-up protocols of abnormal findings. Nursing personnel will perform AIMS assessments at each predetermined time and record the results systematically, and follow-up measures will be implemented according to the protocol. The expected outcome is the enhancement of completed and correctly documented AIMS assessments in reference to full compliance with APA guidelines, thus enhancing the early identification of TD problems..

Desirable Outcomes

Measurable and observable results can be used to conduct systematic assessments of quality improvement interventions and help to effect evidence-based changes in practice in outpatient psychiatry. The main project outcome will be the number of patients with identified new or worsening symptoms of TD increased, and the successful case of this process will be increasing the rate of patients who complete the AIMS assessment to at least 80% of the total cases after the implementation, as APA recommends. The document completeness and follow-up activities will also be measured such as the percentage of assessments that have complete scoring done by AIMS and the ones in which clinical response is documented. Outcome measurement will be done by administering electronic health record audits, measures of the number and quality of successful AIMS screenings done within the 12 weeks of the project.

Secondary outcomes are the nursing staff’s level of competency and confidence in the administration of AIMS, recording of results, and adopting follow-up measures, which will be assessed through pre-test and post-test surveys after the learning courses. The implementation process can be successful and lead to better identification of TD in its early stages, the ability to provide clinical interventions in time, patient safety, and the harmonization of care processes throughout the clinic. There is some evidence that a systematic intervention in the use of standardized screening instruments is highly effective in detecting movement disorders and providing timely clinical treatment (Jackson et al., 2021). The realization of the set measurable outcomes will be a sign of successful implementation of the evidence-based guidelines in the sustainable clinical practice.

Potential Impact

Standardized AIMS screening, structured documentation, and follow-up procedures are likely to contribute to patient safety dramatically, as they would allow identifying the new or progressing symptoms of tardive dyskinesia early. The enhanced documentation will ensure improved communication between the nursing staff, providers, and other members of the care team, and timely clinical decision-making. Unified actions will help minimize variability of patient evaluation and provide equal, evidence-based care in the outpatient clinic (Jackson et al., 2021). It is anticipated that the level of confidence and competence of nursing staff in the identification and management of TD will improve, which will support the professional growth and improve the quality of care delivery.

Learner’s Role for the Project

Implementation of the doctoral project would need effective leadership roles that are backed by expert mentorship to enhance successful change in evidence-based practice. The learner will be the main project leader, as he will plan, implement, and assess all the points of the standardized AIMS screening, structured documentation, and follow-up interventions. Some of the tasks that the leader will undertake are to organize and schedule staff learning sessions, to ensure that the workflow is incorporated into AIMS tests, to track compliance with documentation procedures, and to review the results data to gauge the advancements in TD detection.

It is proven that the success of quality improvement is maximized when the project leaders proactively involve the stakeholders, train them, and plan the systematic implementation and development (Santos et al., 2022). The preceptor will serve as a clinical mentor, guide, and access to patient records, and offer information about organizational barriers or workflow challenges. The use of systematic project management practices and role definition will help the learner to spearhead a sustainable change in practice, improve nursing staff competency, and give a quantifiable change of improvement in the value of early detection and reporting of the symptoms of tardive dyskinesia.

Project Question

Among nursing staff involved in the care of adults with tardive dyskinesia in an outpatient clinic (P), the application of standardized AIMS screening paired with structured documentation and follow-up measures according to the APA requirements (I), as opposed to usual practice (C) during 12 weeks (T) has its effect on the number of patients with documented new or worsening TD symptoms (O)?

PICOT question is a thoughtfully organized tool that helps direct the evidence-based quality improvement efforts and create measurable objectives. The population (P) consists of nursing personnel who represent direct care to adult patients at risk of TD in an outpatient psychiatric clinic. The intervention (I) will be the use of AIMS screening in a standardized format and electronic documentation protocols, and follow-up plans in line with the APA guidelines (American Psychiatric Association, 2025). The comparison (C) is the current practice in which TD screening is inconsistent and is conducted at provider discretion, with documentation being variable or incomplete. 

Outcome measurement will be done by auditing of electronic health records, in which not only the finished AIMS assessment will be captured, but also the follow-up actions recorded. The time (T) will involve 12 weeks; the first weeks will be the implementation phase and staff education, and the remaining weeks will be systematic monitoring and evaluation of screening compliance and documentation quality. The specified structured strategy should help enhance the quality and safety of care and patients, as well as better detect TD at its initial stages.

Conclusion

Regular screening with AIMS (standardized screening), documentation, and follow-up procedures will be used instead of haphazard practices that are currently happening. With nurse staff training, proper evaluation, and the uniformity of intervention would be guaranteed. The improvements that can be measured are that there will be more documented TD assessments and timely clinical follow-ups. The implementation will be successful and will promote patient safety, staff competency, and compliance with evidence-based APA guidelines.

Related assessments for this class: NURS FPX 9000 Assessment 1 and NURS FPX 9000 Assessment 2.