Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
Browse
7 results
Search Results
Item Atypical antipsychotics and metabolic side effect monitoring: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Maricich, Allison Nicole; Chairperson, Graduate Committee: Lindsay BenesSecond-generation antipsychotics (SGAs) have increasingly been utilized by psychiatric providers for patients experiencing a wide array of psychiatric disorders. Originally, SGAs were approved for patients 18 years of age and older; they now have been more consistently utilized in patients under the age of 18. SGAs have significant benefits for many patients, although metabolic side effects from the medication can be detrimental to patients' overall sense of wellbeing. The doctor of nursing practice (DNP) quality improvement (QI) project aimed to improve the metabolic screening rates of adolescent patients admitted to an inpatient residential unit at a pediatric psychiatric hospital. This was done by implementing a paper screening tool that outlined which screening laboratory values had been completed, which needed completing, and when each of these laboratory values were ordered for completion, highlighting a fasting lipid panel, hemoglobin A1c, weight, and blood pressure. A four-week implementation period took place from February 4, 2022 to March 4, 2022. Participants in the project included four psychiatric providers: two psychiatric mental health nurse practitioners (PMHNP) and two psychiatrists. Procedures that took place included (1) providers were educated on the purpose of the QI project and the importance of metabolic screening, (2) the paper screening tool was completed for patients prescribed SGAs, (3) laboratory studies were ordered based on the provider's discretion after completing the paper document, and (4) the paper document was stored and scanned into the patient's chart upon discharge. The results indicated that 75% of patients prescribed SGAs had paper screening tools completed, 85% of patients prescribed SGAs had metabolic screening laboratory studies ordered, and 55% of patients prescribed SGAs had metabolic screening laboratory studies completed. These findings mirrored current literature regarding metabolic screening in patients taking SGAs, suggesting that with the implementation of consistent education, completion of a physical paper screening tool, and systematic ordering of metabolic screening laboratory values, metabolic screening rates improve. The QI project showed success in the preliminary stages and throughout the four-week implementation timeframe, indicating that continuing the project will likely have benefits for adolescent patients prescribed SGAs in residential psychiatric units.Item Managing metabolic side effects: a process improvement(Montana State University - Bozeman, College of Nursing, 2022) Scally, Shannon St. Onge; Chairperson, Graduate Committee: Lindsay BenesOne in 25 people live with severe mental illness (SMI) including schizophrenia, bipolar disorder, and major depressive disorder. People with SMI have an earlier mortality rate by up to 25 years. This is, in part, due to treatment with second-generation antipsychotics (SGAs). SGAs treat positive and negative symptoms but are associated with metabolic side effects (MSEs) such as increases in weight, body mass index (BMI), waist circumference, blood pressure, cholesterol, and blood glucose levels. These MSEs place a person at risk for metabolic syndrome (MetS). To mitigate the impact of MSEs and the development of MetS, patients on SGAs need to have regular screening of MSEs. At a mental health clinic in Western Montana, 32% of patients were prescribed SGAs, yet the clinic had no standardized process to address MSEs. Therefore, this project implemented a standardized process to address the management of MSEs. For each SGA prescription or renewal, patients received an MSE risk discussion, MSE screening, and education regarding lifestyle and diet strategies to prevent MSEs. The process-improvement method used was Plan-Do-Study-Act (PDSA). The results revealed an overall range of adherence to the standardized process: 43% of patients with a new or renewed SGA order had a documented MSE risk discussion and MSE screening ordered. Additionally, 89% of patients with an SGA order received education regarding lifestyle and diet management of MSEs by a nurse health educator. The success of this aspect of the process was facilitated by the nurse health educator and demonstrated a positive step in the sustainability of lifestyle and diet support as a first-line intervention in the prevention of MSEs. The organization now has a standardized process to manage MSEs and a new clinical workflow to support patients in mitigating MSEs. As the organization continues improving the process by adding the EHR automation and continuing support of the nurse health educator role in lifestyle and diet follow-up, the future impact of reducing morbidity and mortality of the SMI population is set in motion.Item Medication reconciliation in ambulatory surgery to prevent adverse drug events(Montana State University - Bozeman, College of Nursing, 2021) Marion, Kirsten Ayres; Chairperson, Graduate Committee: Amanda H. LucasAdverse drug events (ADEs) cause a significant burden to the healthcare system. Medication reconciliation (MR) is a well-documented method to reduce ADEs in a variety of healthcare settings. The purpose of this project was to determine best practice for performing MRs, implement best practice into practice, and evaluate outcomes based on successful completion of MRs. This project was implemented at an ambulatory surgery center (ASC) in southwestern Montana with a focus on adult orthopedic patients. Four PDSA cycles were completed over a 6-week period to improve the MR process. Improvement of the MR process was deemed necessary to meet evidence-based MR guidelines for patient safety and to meet accreditation standards. The definition of a complete MR was based on current literature and state and national accreditation guidelines. Over the 6-week process, MR completion rates increased from 0% at implementation to 52% at project completion. Continuation of improvement utilizing the processes implemented in this project is recommended.Item Improving treatment of metabolic side effects from atypical antipsychotics(Montana State University - Bozeman, College of Nursing, 2021) Galahan, Alicia Marie; Chairperson, Graduate Committee: Margaret HammerslaAtypical antipsychotics are commonly used to treat a variety of mental health disorders in children and adolescents. Prescribing atypical antipsychotics is not without risk as the development of metabolic side effects can lead to reduced life expectancy from chronic metabolic diseases. The metabolic side effects from atypical antipsychotics are considered treatable medical conditions requiring appropriate screening and intervention. Despite recommendations, psychiatric providers do not consistently screen and treat metabolic abnormalities, creating a gap in care for these individuals. This quality improvement project took place on an adolescent inpatient residential unit. This project focused on incorporating recommendations from clinical practice guidelines by focusing on improving rates of metabolic screening and utilization of treatment interventions when metabolic abnormalities are identified to reduce the burden of metabolic side effects for patients. The Plan-Do-Study-Act framework was used to guide this quality improvement project over six weeks with four separate cycles varying in duration from one to two weeks each. A metabolic screening bundle for psychiatric provider notes was created within the electronic health record to improve ease of interpreting metabolic screening values and identifying need for further intervention. At the end of the quality improvement project, rates of metabolic screening remained unchanged. The rate of patients receiving treatment interventions increased and multiple patients received more than one treatment intervention. Treatment modalities studied included metformin, individual physical activity, and nutritionist consult. This quality improvement project sought to decrease patients experiencing metabolic abnormalities after treatment with atypical antipsychotic medication, but effectiveness was unable to be measured due to the short time frame. Metabolic screening is a necessary part of atypical antipsychotic treatment that needs to be completed upon initiation of medication and at future appointments. Once metabolic screening is completed, further education on potential treatment interventions for metabolic abnormalities needs to be discussed with the patient and other professionals involved in their care to improve patient outcomes.Item Safety improvement in biologic therapy for patients with moderate to severe plaque psoriasis: a pilot project and quantitative analysis(Montana State University - Bozeman, College of Nursing, 2016) Addison, Kara Marie; Chairperson, Graduate Committee: Jennifer SofieBiologic Response Modifier (BRM) medications are indicated for moderate to severe psoriasis and demonstrate high efficacy for disease reduction. Although BRM medications are considered the most effective therapy in the treatment of moderate to severe plaque psoriasis, their side effect profile can be severe. Using BRMs may increase the risk of infections, demyelinating disease, and malignancy (Reich, Burden, Eaton, & Hawkins, 2012). With such established risks, baseline assessments and monitoring have been recommended. However, no standardized guidelines exist for the monitoring of BRM medications (Hanson, Gannon, Khamo, Sodhi, Orr, & Stubbings, 2013). Therefore, the objective of this scholarly project was to implement a BRM monitoring protocol into the Electronic Medical Record (EMR) of a Montana dermatology clinic to improve provider monitoring compliance and therefore improve psoriasis patient outcomes, safety, and education. Monitoring criteria were developed based on recommendations from the University of Illinois Medical Center Clinical Care Guidelines and the American Academy of Dermatologists Biologic Monitoring guidelines. A BRM Electronic Medical Record (EMR) template was then created to utilize such guidelines to improve clinical compliance and patient safety. Seven main criteria were measured for completion including laboratory studies, physical assessment, patient education, follow up, psoriasis severity scale, immunizations, and vital signs. Side effects experienced and patient comorbidities were also recorded. Completion rates of the protocol were analyzed using before and after comparisons, the paired t-test, and McNemar's test. Before the intervention was implemented, 54% of charts had completion of all seven categories and after the intervention 98% of charts were completed, illustrating a 44% improvement in provider compliance and monitoring. The paired t-test illustrated an average difference of 0.43 with a standard error of .029. The McNemar's test established a positive association between implementation of the BRM protocol and improvement in provider compliance. 40% of patients experienced co-morbidities associated with psoriasis and 25% of patients experienced side effects related to BRM therapy. These project findings demonstrated the efficacy of a BRM monitoring template for improving provider-monitoring compliance and improving patient safety through early identification of comorbidities and side effects.Item The relationship of background medical knowledge to the incidence of untoward drug reactions(Montana State University - Bozeman, College of Professional Schools, 1970) Larsen, Alberta AnnItem Managing antipsychotic induced metabolic syndrome to improve treatment adherence and quality of life in Gallatin County(Montana State University - Bozeman, College of Nursing, 2015) Frye, Shelby Leigh; Chairperson, Graduate Committee: Laura LarssonAtypical antipsychotics are prescribed for patients suffering from serious mental illnesses. As these medications have become more widely used over the past 3 decades, practitioners have started to become more aware of metabolic side effects caused by them. Metabolic syndrome is a term for alterations in baseline metabolic functioning which result in weight gain, hyperlipidemia, hypertension, insulin resistance, diabetes, and cardiovascular disease. A correlation between obesity and mortality exists within the population of individuals diagnosed with a severe mental illness taking atypical antipsychotics and has been reported as responsible for decreased life expectancy of up to 30 years. However, monitoring the physical side effects has been a significant barrier to successful management for these patients, often due to unclear practice direction between psychiatric and primary care providers. Many patients with metabolic syndrome experience exacerbations in their mental illness such as increased depression, anxiety, and isolation related to discomfort and decreased self-esteem, which can lead to medication nonadherence causing further complications. Patients experiencing emotional decline may be unable to participate in necessary lifestyle modifications without assistance, leading to the progression of metabolic syndrome. Such health related spirals contribute to the development of treatment resistance and poor patient outcomes. At the Gallatin Mental Health Center in Bozeman, MT, 23 patients taking atypical antipsychotics were provided a qualitative satisfaction survey about medications, treatment plans, and adherence, in addition to being offered an opportunity to make recommendations that could improve their overall health. In accordance with research and successful interventions internationally, a significant number of the patients in Bozeman have experienced metabolic changes, have difficulty remembering or understanding treatment goals, and would like assistance with lifestyle interventions. Using evidence based research and recommendations for metabolic syndrome prevention assessments and interventions a physical health assessment checklist for psychiatric nurses at Gallatin Mental Health was created. An assessment key to assist the nurse with the checklist, a prefabricated order set of interventions, and a simple care plan to guide best practice policy implementation will provide for better treatment adherence and improved quality of life for patients taking atypical antipsychotics in Gallatin County.