‘Are we doing it right?’ – insights from a Norwegian multicentre study on antipsychotic management of psychotic disorders

Knowledge about how medication management in the treatment of psychosis aligns with guideline recommendations is limited. This study aimed to investigate the extent to which current antipsychotic medication management adheres to guideline recommendations for the treatment of psychotic disorders in specialist mental healthcare in Norway.
Antipsychotic medication management was assessed using 44 criteria from the Antipsychotic Medication Management Fidelity Scale in Norwegian public mental health specialist units. The scale measures adherence (fidelity) to core components of medication management, as recommended in guidelines, at both unit level (N = 16 units) and patient level (N = 147 patient records).
At the unit level, the mean fulfilment of criteria for maintaining a list of current medications and for systematic monitoring of side-effects were 8.8 (55%) and 5.5 (34%) units, respectively.
At the patient level, lists of medications and doses were systematically updated in 112 (76%) patient records. The choice of antipsychotic medication and dosage was in accordance with the guidelines in 79 (54%) and 69 (47%) patient records, respectively. Mean fulfilment of criteria for monitoring and reducing side-effects was 42.8 (29%) patient records. Systematic monitoring of symptoms was not documented in any patient record.
Our study found structural and procedural shortcomings in medication management for psychosis in specialist mental healthcare. Low adherence to guidelines poses a significant patient safety risk. Addressing the implementation of clinical guidelines is essential to improve patient outcomes and the quality of care in specialist mental health services.
NCT03271242, 5 Sept. 2017.