Atypical antipsychotics and metabolic side effect monitoring: a quality improvement project

Abstract

Second-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.