Conducting the AIMS assessment: train your team, plan ahead, and adapt for virtual appointments

The AIMS assessment is a qualitative tool for diagnosing and monitoring involuntary movements caused by antipsychotic medications. Learn how some clinicians plan their day to make sure there’s time to conduct the assessment for patients who need it, including advice on virtual assessments.

When treating patients with antipsychotic prescription drugs, finding the right medication balance requires blood work and other diagnostic tests to monitor for efficacy, tolerance, and side effects.?

But there’s one assessment that is often overlooked entirely or simply overshadowed by the concerns around metabolic side effects—the abnormal involuntary movement scale (AIMS), recommended by The American Psychological Association (APA) as the standard of care to screen for drug-induced movement disorders (DIMDs).

This qualitative assessment is designed to uncover movements tied to antipsychotic use (e.g., excessive blinking, abnormal jaw movements, shaking, tremors, or stiffness), and periodic screening is suggested every six to twelve months or as needed if DIMD symptoms are noticeably escalating.

In March 2024, Amalgam Rx conducted 30 in-depth interviews with healthcare providers who regularly prescribe antipsychotics. These experienced clinicians shared their experience using AIMS and how they integrate the assessment into their practice, including the importance of treating this assessment like routine monitoring.

Watch our Becker’s webinar about AIMS, including best practices for scheduling and workflows.

The challenge of AIMS in primary care settings

Many patients taking antipsychotic medications are treated by primary care clinicians with limited expertise on their conditions. The clinicians we spoke to reported feelings of uncertainty and inadequacy. One doctor said she often felt like she was forced to “practice psychology without a license.”?

Primary care also has highly restrictive appointment schedules compared to those in behavioral health or psychiatric settings. These short durations, paired with the prioritization of various co-morbidities, mean that AIMS is frequently passed over for other priorities.

While that decision might be reasonable considering the circumstances, the clinicians we interviewed told us that it’s simply not in the patients’ best interests to skip the AIMS assessment. The APA agrees.?

The updated 2021 APA guidelines for the treatment of patients with schizophrenia recommends an assessment with a “structured instrument”:

• When antipsychotic medications are initiated The guidelines recommend that initial or baseline clinical assessment of abnormal involuntary disorders, including tardive dyskinesia (TD), is conducted when antipsychotic medication is first prescribed.?
• At ongoing, regular intervals They also recommend screening occurs “at a minimum of every present 6 months in patients at high risk of tardive dyskinesia and at least every 12 months in other patients as well as if a new onset or exacerbation of preexisting movements is detected at any visit.”

While some of the providers we interviewed cited primary care’s short appointments and competing priorities as challenges inhibiting their use of AIMS, others shared ways they’ve developed to make sure the assessment is completed whenever it’s necessary.

Specifically, they mentioned three best practices to help make sure every patient receives an assessment when they need it:

1. Train clinical team members to conduct AIMS.
2. Review daily appointments ahead of time.
3. Conduct AIMS virtually (if needed).

Train clinical team members to conduct AIMS

While some providers prefer to conduct the screening themselves, this task can also be delegated to other qualified members of the care team, including nurses, medical assistants, and behavioral health techs.?

For example, some clinicians interviewed reported success with training nurses to perform AIMS and then incorporating the assessment when patients come in for routine bloodwork. By adding it to regular lab workflows, nurses could provide the screening required and avoid negatively impacting the provider’s appointment schedule.?

No matter what the workflow looks like, it’s important to be consistent. The AIMS assessment is subjective, so standardized training and adherence to protocol is crucial for reliable tracking of symptoms over time.

Review daily appointments ahead of time?

The clinicians we interviewed recommend reviewing each day’s upcoming appointment schedule to see if the AIMS screening will be needed. If there are appointments with patients who are on antipsychotics and don’t have an up-to-date AIMS score in their chart, you can be proactive in making sure a qualified team member is available to conduct the assessment at the appropriate time.

Batching these appointment types on certain days is another option to consider. Some providers reported that this made it easier for them to set aside time for the screenings with minimal disruption to the schedule.

They also suggested asking patients to arrive 10-15 minutes early to allow time for the screening, in lieu of having to make a separate trip to the clinic.

Conduct AIMS virtually (if needed)

Certain aspects of the assessment are best done with physical touch (e.g., such as testing the rigidity in a patient’s arms). However, AIMS screenings can be done virtually as part of an overall strategy for diagnosing and monitoring DIMDs and supporting patients’ medication management.?

While an in-person assessment is ideal, a virtual AIMS assessment can serve as an acceptable option between in-person assessments or when the patient is not able to attend an on-site visit for any reason.

Note: Conducting an AIMS assessment virtually requires that both you and the patient have a stable internet connection. If the video feed lags, freezes, or is pixelated, you might miss important details.?

Be sure to model each exercise for the patient as well, ensuring you are clearly visible on their screen. Similarly, the patient should be able to stand several feet back from their device to give you a full-body view when needed.

Best Practices for Virtual Administration of AIMS?

• Ideally, patients should have an in-person AIMS assessment within six months before a virtual visit and at least one in-person assessment six months later.
• All virtual assessments should include video. Be sure to provide prior instructions to patients about the required technology setup.
• Encourage family members and caregivers to join and voice any concerns about the patient's condition(s), medication(s), and involuntary movement(s).
• Model movements for patients before asking them to complete an exercise.
• Tie movements to functions they perform in their daily lives (e.g., walking, eating, dressing, attending work, etc.).
• Educate the patient and their caregivers on approved medications for DIMDs.

Other best practices for AIMS

Patients taking antipsychotics require long-term monitoring for DIMD symptoms regardless of whether they see a mental health specialist or a primary care clinician. Beyond preparing for needed AIMS assessments each day, the clinicians we spoke to shared other best practices that may help with conducting the assessment and making it the standard of care at your organization.

• Treat AIMS like routine monitoring. Make it a non-negotiable part of patient care. By prioritizing this way, you can make sure every patient gets the support they need regardless of time restrictions and hectic schedules.?
• Bill appropriately for the assessment. You can bill for AIMS under certain circumstances. Be sure to check with a qualified billing expert first.
• Embed AIMS reminders into the EHR. When a patient’s chart shows the requisite criteria that necessitates an AIMS assessment, an advisory makes the recommendation and provides easy options for making sure it gets done.

Visit Amalgam Rx.com/AIMS to learn more about how you can support a vulnerable patient population by bringing this important assessment to your organization.