A Nurse-Led Clinical Practice Guideline to Improve Medication Adherence Among Psychiatric Home-Health Patients

Medication nonadherence among psychiatric patients receiving home-health services contributes to symptom relapse, preventable hospitalizations, and decreased quality of life. Inconsistent medication education and adherence monitoring within home-health settings may further exacerbate this problem. The purpose of this Doctor of Nursing Practice project was to develop and evaluate a nurse-led clinical practice guideline (CPG) designed to improve medication adherence among psychiatric home-health patients. The practice-focused question asked: What evidence, based on content expert review using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, supports the quality and usability of a CPG to improve medication adherence in a psychiatric home-health setting? The CPG was developed using the Johns Hopkins Evidence-Based Practice Model and informed by current literature supporting nurse-led psychoeducation, motivational interviewing, structured adherence assessment, and caregiver involvement. A multidisciplinary panel of four content experts evaluated the guideline using the AGREE II instrument. Domain scores ranged from moderate to high, with highest ratings in scope and purpose (M = 6.8), stakeholder involvement (M = 6.7), and clarity of presentation (M = 6.8). Applicability (M = 6.0) and editorial independence (M = 6.2) also received strong ratings, while rigor of development received a moderate score (M = 5.4). Findings support the overall quality, clinical relevance, and usability of the guideline for implementation in psychiatric home-health practice. Standardizing nurse-led medication education and adherence monitoring promotes consistency in care delivery, supports patient engagement, and enhances continuity of care. Implementation of this CPG has implications for improving medication adherence behaviors, reducing psychiatric-related hospital readmissions, and promoting equitable access to evidence-based interventions for vulnerable populations receiving care in the home.