Timely Follow Up Care After Initiation of ADHD Medication in Children: A Quality Improvement Project

Date of Award

Fall 2020

Project Type

Clinical Doctorate

College or School


Program or Major


Degree Name


First Advisor

Pamela DiNapoli


Background: Enhancing medication safety, strengthening compliance and mitigating side effects requires close monitoring. A child, defined by Centers for Medicare and Medicaid Services, as being between the ages of 6 years and 12 years of ages, with Attention Deficit Hyperactivity Disorder (ADHD) must have an initial medication visit within 30 days of a first-time trial of ADHD medication. Increasing staff awareness of organizational policy of expected timeframe for medication checks and annotating appointment slots as initial medication checks will decrease the number of days between the first-time trial of ADHD medication and a child’s medication assessment.

Methods: The Model for Improvement and Plan, Do, Study, Act structure for quality improvement worked well for this project. A 3-month retrospective chart review was completed, prior to the implementation of the intervention. A total of 600 charts were reviewed for the start date of ADHD medication and date of initial medication assessment.

Intervention: Administrative staff and APRNs were educated about CMS measures and organizational controlled medication policies. Appointment slots were annotated as initial medication checks. Due to COVIS 19, the visit platform was changed from in person to telehealth. CMS measures, organizational policy and process changes were included in a weekly email to both administrative staff and APRNs.

Results: Follow up chart reviews (n=591) revealed the mean number of days between starting an ADHD medication to the initial medication assessment, in the 3 months after implementation, decreased from 43 days to 20 days, an overall reduction of 23 days or 73%, meeting both CMS measures and organizational policy.

Conclusion: Increased awareness, reinforcement, annotation of appointments and a change to telehealth platform successfully decreased the mean number of days between ADHD medication initiation and follow up medication evaluation. Limitations include: the project taking place in the setting of an epidemic, an announcement that The ADHD Center would be closing and not having data to compare in person visits to telehealth visits.

Keywords: ADHD, medication, initiation

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