Managing metabolic side effects: a process improvement

Abstract

One 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.