Theses and Dissertations at Montana State University (MSU)
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/732
Browse
5 results
Search Results
Item Implementing metabolic monitoring in second-generation antipsychotic use: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Stone, Amanda Marie; Chairperson, Graduate Committee: Lindsey Davis; This is a manuscript style paper that includes co-authored chapters.Background: Roughly one in five adults in the United States live with a psychiatric disorder, including major depressive disorder, bipolar disorder, and schizophrenia. Despite their effectiveness in treating psychiatric disorders, second-generation antipsychotics (SGAs) are associated with an increased rate of metabolic side effects (MSEs). To reduce the impact of MSEs and the potential development of metabolic syndrome, individuals on SGA need routine metabolic screening. Local problem: At an outpatient mental health clinic, 21% of the patients were prescribed SGAs; however, the clinic lacked a standardized protocol to assess MSEs. This project aimed to increase the completion rate of metabolic monitoring and improve patient health outcomes in patients diagnosed with a psychiatric disorder. Methods: A multifaceted approach was created for providers to increase adherence to metabolic screening in SGA use. Interventions: Three interventions were initiated: an electronic health record macro was created to promote consistent provider documentation, a standardized metabolic monitoring process, and educational in-services performed to encourage screening adherence. Results: The project aims were achieved with the clinic maintaining an 80% blood pressure (BP) completion rate. Documentation of body mass index (BMI) increased by 72%. Appropriate lab monitoring improved from an 8.5% rate during the preintervention phase to a rate of 33% postintervention. There were no changes in provider perceptions and practices regarding metabolic monitoring in SGA use. Conclusion: The project effectively increased the rate of metabolic monitoring in individuals prescribed an SGA.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 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 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.Item The experience of adult women with schizophrenia who take second generation antipsychotics(Montana State University - Bozeman, College of Nursing, 2013) Moon, Allison Gayle; Chairperson, Graduate Committee: Patricia A. HolkupA gap in the scientific literature exists regarding the concerns of adult women about taking second generation antipsychotics (SGA). No research existed that represented the exclusive experience of women who take SGA. A qualitative study of the experience of adult women between the ages of 19-44 with the diagnosis of schizophrenia was conducted. Participants were recruited through the distribution of flyers by physicians at two mental health centers in the Northwest. One participant contacted the interviewer by phone and an interview was completed in a private setting. The interview was transcribed and analyzed using Luborsky's method for thematic analysis (1994). Topics and patterns were identified and then subsequently compared with the Health Promotion Model (Pender, Murdaugh & Parsons, 2011). Topics included: a) getting to know the illness, b) experiencing the effects of medications, c) appreciating the therapeutic effects of medications, d) feeling irritated with the illness, and e) learning how to manage the illness. Difficulties with recruitment indicate a need for further study to determine the best way to access this unique population.