Priority action after receiving a back-referral slip
The four options all describe legitimate components of community-based continuing care for a client with schizophrenia. However, the question asks which action the nurse should perform first after the slip arrives at the RHU. The back-referral slip is the formal handoff document from the provincial hospital. It contains the diagnostic findings, the specific antipsychotic prescribed, the dosage and frequency, the psychiatrist’s follow-up plan, and any precautions or laboratory monitoring recommendations. The nurse must review this document before initiating any direct client or family intervention, because the slip defines the treatment parameters that all subsequent actions must support.
In the Philippine primary care setting, the RHU nurse serves as the coordinator of the referral loop. When a client is discharged from a higher-level facility with a back-referral, the receiving health worker is responsible for continuity of care. Continuity of care means that the hospital’s assessment and plan are not duplicated or contradicted at the community level. Scheduling a home visit, arranging the monthly medicine supply, or linking the family to a support group are all valuable, but each one depends on knowing what the hospital actually ordered. For example, the nurse cannot verify whether the client is taking his medicine correctly if she has not first confirmed the prescribed drug, dose, and frequency from the slip.
Watch out! The question tests the nursing process sequence. Assessment and data review precede planning and implementation. Reviewing the slip is the assessment step; the other three options are implementation steps.
The evidence base reinforces why this initial review matters. Studies in rural, resource-limited settings consistently identify medication nonadherence as a major driver of relapse and rehospitalization in schizophrenia [1][3][4]. A systematic review of mHealth interventions found that improving adherence is the primary target of most community-based strategies for schizophrenia spectrum disorders [2]. However, none of those adherence-promoting interventions can be safely applied until the nurse knows the exact regimen the client is supposed to follow. The back-referral slip is the single source of truth for the prescribed antipsychotic regimen, and reviewing it first prevents errors such as reinforcing the wrong dose or omitting a required monitoring step.
There is also a systems-level reason for this priority. In rural health delivery, clients with severe mental illness are at high risk of being lost between levels of care [1][3]. The back-referral process is designed to close that gap. If the nurse skips the review and proceeds directly to a home visit, she may arrive without knowing whether the hospital recommended a specific follow-up date, a laboratory test, or a family psychoeducation session. Key point! The first action is not the most visible or client-facing one; it is the action that ensures all other actions are correct and coordinated.
The table below contrasts the four options in terms of the nursing process phase and why each cannot be done first.
| Option | Nursing process phase | Why it is not the first action |
|---|
| 1. Schedule a home visit to see how he takes his medicine | Implementation | Requires knowing the prescribed drug, dose, and frequency from the slip before adherence can be assessed. |
| 2. Review the findings and care plan written on the slip | Assessment / data review | This is the correct first step. It establishes the baseline for all subsequent care. |
| 3. Arrange his monthly medicine supply at the RHU | Implementation | Cannot be done accurately without confirming the exact medication and quantity ordered by the hospital. |
| 4. Link the family with a mental health support group | Implementation | Support group referral should be tailored to the family’s needs and the hospital’s recommended follow-up plan. |
In community mental health nursing, the back-referral slip is analogous to a physician’s order sheet in the inpatient setting. A nurse would never administer a medication without first reading the order. Similarly, the RHU nurse should not initiate any community intervention without first reading the hospital’s order and plan. Reviewing the slip first ensures that the home visit, the medicine supply, and the family support all build on the same foundation and that the client is not lost between levels of care.
References (research sources)
- [1]
Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation.RCT/clinical trialCai Y, Gong W, He W, He H, Hughes JP, Simoni J (2022) · DOI: 10.2196/33628
- [2]
Effectiveness of M-Health Interventions to Improve Medication Adherence in People with Schizophrenia Spectrum Disorder: A Systematic Review.Meta-analysis/systematic reviewTemesgen WA, Lai YY, Suen HN, Chan WY, Yau PT, Chien WT, Chong YY. (2026) · DOI: 10.3390/nursrep16090303
- [3]
Feasibility and preliminary effectiveness of electronic medication monitoring system to improve antipsychotic adherence: a type 1 effectiveness-implementation hybrid pilot study.Research articleWang RS, Hu H, Zhang M, Li W, Li M, Tong G, Luo S, Wang H, Yang B, Zuo Z, Wang C, Li Z, Long X, Xu L, Niyibizi J, Zhao R, Wang Y, Li B, Tian Y, Tang Y, Zhang T, Xu DR. (2026) · DOI: 10.1186/s12888-026-08103-z
- [4]
Effects of Motivational Interview-Based Cognitive Therapy in Patients With Schizophrenia: A Multicenter Randomized Controlled Trial.RCT/clinical trialChen YL, Liu CY, Liu CY, Yang CY. (2026) · DOI: 10.1097/jnr.0000000000000761