Implementing metabolic monitoring in second-generation antipsychotic use: a quality improvement project

Abstract

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.