ABSTRACT

Background: In psychiatric care, metabolic monitoring for patients on second generation antipsychotics (SGAs), including second generation long-acting injectables antipsychotics (LAIs) is often overlooked. Clinicians lack adherence to the most up-to-date consensus guideline created by the American Diabetes Association and American Psychiatric Association related to metabolic testing.

Purpose: This quality improvement project aimed to increase weight and waist circumference order placement by providers treating patients on LAIs, for nurses to complete each order, and to improve attitudes, knowledge, and confidence of providers in relation to metabolic monitoring.

Methods: A pre- and post-survey called the M-BACK questionnaire was used to evaluate providers’ views on metabolic monitoring. Guideline tools were created and used during the project to reflect the most up-to-date metabolic monitoring practices for patients on second generation antipsychotics.

Intervention: The project created a guideline-congruent Provider Guideline Tool focusing on metabolic monitoring practices, which could be used by providers to ensure metabolic monitoring and follow-up. An educational meeting for providers on how to use the Provider Guideline Tool was completed, and there was use of a Metabolic Monitoring Nursing Role Sheet to guide the nurse on how to complete metabolic measurements ordered by providers.

Results: Out of 13 injection appointments, there was a 100% adherence to metabolic monitoring order placement, and a 100% completion rate of the orders by the nurse after the interventions were put into place. The questionnaire results indicated that there was no significant improvement in attitudes, knowledge, or confidence for providers in relation to metabolic monitoring after education.