Dietary supplement use and safety in psychiatric populations

Abstract

The prevalence of dietary supplement use continues to grow nationally and is found to be higher in patients with a psychiatric diagnosis. Dietary supplements may lack regulatory oversight and are not always extensively tested, which may increase the risk of adverse medication interactions when used with psychotropic medications. Improving PMHNP awareness through standardized nurse screening and documentation workflows may increase visibility of dietary supplement use and support clinical decision-making. Screening, documentation, and education on dietary supplement use within a rural outpatient health clinic were inconsistent, limiting providers' visibility into dietary supplement use and potentially contributing to patient safety risks. A quality improvement project using the Plan-Do-Study-Act (PDSA) framework was implemented with a single psychiatric mental health nurse practitioner (PMHNP) over six weeks. Biweekly chart audits of randomly selected encounters evaluated documentation and distribution of education, reviewing 25 charts per cycle across three PDSA cycles. Baseline documentation and screening of dietary supplement use occurred 39% of the time. During the first PDSA cycle, documentation compliance declined slightly to 36%. The following consecutive cycles produced a steady increase reaching 76% by the end of the six-week period. Patient education was estimated at approximately 10% of patient encounters at baseline and increased to 72% by the end of the project. Standardized screening, documentation, and education were associated with improvements in documentation and education processes and increased visibility of dietary supplement use within the clinical record. Further evaluation is needed to determine whether these changes translate into improvements in patient safety and clinical outcomes.