Minimizing side-effects: the clinical impact of nurse-administered 'side-effect' checklists

For those with chronic illness, the adverse effects of medication are important causes of morbidity and distress which may not always receive due attention. Guidelines and checklists may be one strategy to focus professionals' attention on long-term problems. Therefore, client-centred 'side-effect' evaluation checklists were developed to be administered and actioned by nurses.

The purpose of this study was to explore the clinical impact of these checklists on long-term users of antipsychotic medication.

This study was undertaken with clients with enduring mental illness, in Community Mental Health Teams. In the first phase, 40 nurse-client interactions were observed. Following introduction of the evaluation checklists, 20 nurse-client interactions were observed with the checklists and 20 nurse-client interactions were observed for comparison. In addition, the views of professionals, service users and user groups on the value of the checklists were sought.

Amongst the 20 clients in the intervention group, the checklists highlighted several problems, two of which were urgent. In the intervention group, the mean number of problems actioned per client increased from 0.35 (range=0-4) with no checklists to 3 (range=0-6) with the checklists. The majority (51 of 59) of actions taken to alleviate adverse effects of medication concerned physical health problems. Nurses offered appropriate advice or encouraged clients to contact the relevant agencies. No such changes were observed in the comparator group. There were no differences between groups in the number of referrals to prescribers.

The usefulness of the evaluation checklists for detecting unattended problems, in conjunction with the responses of service users, suggests that it may be clinically effective to establish procedures to systematically monitor people with serious mental illness for adverse drug reactions (ADRs). However, larger studies are needed to confirm this.