Integrating AIMS into routine antipsychotic medication monitoring

The AIMS assessment is a qualitative tool for diagnosing and monitoring involuntary movements caused by antipsychotic medications. Learn how some clinicians leverage the power of their care team and existing workflows to make sure every patient taking antipsychotics is monitored regularly.?

The abnormal involuntary movement scale (AIMS) was designed to identify the onset and progression of drug-induced movement disorders (DIMDs) caused by antipsychotic medications, like tardive dyskinesia (TD). This qualitative exam helps capture indicative movements a patient is demonstrating, and it is recommended as the standard of care by the American Psychiatric Association (APA).

In March 2024, Amalgam Rx conducted 30 in-depth interviews with healthcare providers who regularly prescribe antipsychotics. These experienced clinicians shared several best practices on how they integrate AIMS screening into their day-to-day practice, which notably includes the importance of treating the assessment like any other ongoing, routine monitoring.

The importance of routine screening for DIMDs

According to an AIMS webinar hosted by Amalgam Rx, 70% of individuals with TD are undiagnosed, and many patients presenting symptoms don't realize the movements are even happening. A family member or healthcare professional is often the first to notice.

Even patients who are aware of the movements may try to hide them for fear of embarrassment. Other times, they simply have more pressing health concerns to address or are reluctant to disrupt a medication routine that works for them.?

A small twitch can be easily disguised or may not concern the affected individual at first. However, symptoms can worsen over time and can eventually become permanent.

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

Consistent AIMS screening can help slow, stop, or even reverse DIMDs by uncovering the need for intervention or medication rebalancing. Diagnosing the involuntary movements early and tracking them over time is crucial.?

When should AIMS be conducted??

Generally, there are no hard and fast rules on how frequent AIMS should be conducted. The decision is left to providers, based on each patient’s medical history, pre-existing conditions, and other medications.

More specifically, the APA guidelines recommend periodically assessing DIMDs when the following criteria are met.

• When antipsychotic medications are initiated. The guidelines recommend that initial or baseline clinical assessment of abnormal involuntary disorders, including TD, is conducted when antipsychotic medication is first prescribed or when inheriting new patients without a recent documented AIMS assessment.?
• At regular intervals after beginning antipsychotic medications. The APA recommends screening occurs “at a minimum of every 6 months in patients at high risk of tardive dyskinesia and at least every 12 months in other patients.” Additional assessments are recommended as needed “if a new onset or exacerbation of preexisting movements is detected at any visit.”

Incorporating AIMS into routine workflows

According to the clinicians we talked with, it’s best to conduct and document the AIMS just like any other routine monitoring, no different than testing for metabolic side effects.

Dr. Jordan Howard, a board-certified psychiatrist in Alpharetta, Georgia, told us, “It’s very important to build a reliable and efficient approach so that each time we inherit a patient or continue a patient on treatment, we know which parameters are in place. These may include metabolic labs, AIMS, pregnancy tests, thyroid levels, CBCs, etc.”?

He added, “Tying it in with other services that we know are important in monitoring for the medication class is very helpful…Once I see a patient is on an antipsychotic, the first thing I want to know is when their most recent metabolic labs were done. On that same note, I want to see when their most recent AIMS was done.”

Another clinic we spoke with pairs any available clinician with a patient who needs an AIMS, even if they are not managing that patient’s medications. They also plan ahead each day to make sure someone is available on-site to conduct the assessment before or after a patient’s scheduled appointment time. It works well for the practice because patients don’t have to make a separate appointment or lose session time with their providers.?

Other best practices for AIMS

Beyond incorporating AIMS into routine workflows, the clinicians we spoke with shared other best practices that may help make the assessment the standard of care at your organization.

• Plan your clinic day to make time for AIMS. Review upcoming appointments to see if the AIMS screening will be needed for patients. Take a look at this article for more on how to get started.?
• Bill appropriately for the assessment. Some practices can receive reimbursements for conducting AIMS. Find more information in the linked article, and always check with a qualified billing expert before making any decisions.
• Embed AIMS reminders into the EHR. A free clinical advisory can be implemented into your EHR to recommend conducting an AIMS assessment when a patient’s chart shows the requisite criteria. Get the details here.

Visit www.amalgamrx.com/aims to learn more about how you can support a vulnerable patient population by bringing this important assessment to your organization.