Monitoring Adverse Cardio- Metabolic Effects of Antipsychotic Use in a Behavioral Health Unit

Background: Studies suggest that individuals with serious mental illness have higher rates of morbidity and premature mortality compared to the general population. Atypical antipsychotics are used to a myriad of psychiatric disorders but evidence suggests that treatm ent with these medications is associated with several adverse cardio -metabolic (CM) effects such as obesity, hyperglycemia, and hyperlipidemia. Despite published recommendations for screening and monitoring patients receiving antipsychotics, healthcare professionals may not routinely assess or monitor these patients for adverse CM effects. Purpose: The purpose of this quality improvement project was to evaluate current CM risk monitoring practices of Intermountain Healthca re (IHC) clinicians and whether Ce nters for Medicare and Medicaid Services ( CMS ) guidelines and criteria for monitoring and documentation were being met. In addition, the prevalence of adverse CM effects was analyzed. A clinical practice guideline (CPG) was developed for clinicians' use to improve monitoring rates on the unit. Methods: This quality improvement project was implemented in an adult Behavioral Health Unit (BHU) using a retrospective patient chart review (n=60) who were receiving antipsychotics at the time of their discharge fro m the unit. A survey of the providers was conducted to identify barriers to routine monitoring for adverse CM effects. A CPG in the form of a flowchart was designed to address barriers and increase monitoring rates. A follow - up survey of the providers was conducted to elicit feedback regarding the guideline content, relevance, and clinical utility. Results: Of the 60 charts reviewed, 72% had documented appropriate CM monitoring. A majority of the patients (92%) had at least one co -morbid metabolic conditi on, the two most common being dyslipidemia (72%) and overweight or obesity (70%). The BHU providers identified five barriers that preclude consistent CM monitoring of all BHU patients. The CPG was presented to providers for review of content and utility. F eedback was incorporated into the final version. All providers indicated that the CPG was relevant and expressed a high likelihood of using it in practice. Conclusions. Current BHU metabolic monitoring for medication side effects meets CMS criteria. The prevalence of CM health problems was high in the patient charts reviewed. Several barriers to CM monitoring were identified on the unit and these will need to be addressed. Use of clinical tools that have potential to decrease those barriers may help change provider practice. Further research is required to determine whether use of the CPG results in higher monitoring rates.