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Can We Improve Physical Health Monitoring for Patients Taking Antipsychotics on a Mental Health Inpatient Unit?

Ross, Elyse, MD*; Barnett, Rebecca, MD*; Tudhope, Rebecca, MD, FRCPC; Vasudev, Kamini, MBBS, MD, DNB, MRCPsych*

Journal of Clinical Psychopharmacology: October 2018 - Volume 38 - Issue 5 - p 447–453
doi: 10.1097/JCP.0000000000000931
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Background Patients with severe mental illness are at risk of medical complications, including cardiovascular disease, metabolic syndrome, and diabetes. Given this vulnerability, combined with metabolic risks of antipsychotics, physical health monitoring is critical. Inpatient admission is an opportunity to screen for medical comorbidities. Our objective was to improve the rates of physical health monitoring on an inpatient psychiatry unit through implementation of an electronic standardized order set.

Methods Using a clinical audit tool, we completed a baseline retrospective audit (96 eligible charts) of patients aged 18 to 100 years, discharged between January and March 2012, prescribed an antipsychotic for 3 or more days. We then developed and implemented a standard electronic admission order set and provided training to inpatient clinical staff. We completed a second chart audit of patients discharged between January and March 2016 (190 eligible charts) to measure improvement in physical health monitoring and intervention rates for abnormal results.

Results In the 2012 audit, thyroid-stimulating hormone (TSH), blood pressure, blood glucose, fasting lipids, electrocardiogram (ECG), and height/weight were measured in 71%, 92%, 31%, 36%, 51%, and 75% of patients, respectively. In the 2016 audit, TSH, blood pressure, blood glucose, fasting lipids, ECG, and height/weight were measured in 86%, 96%, 96%, 64%, 87%, and 71% of patients, respectively. There were statistically significant improvements (P < 0.05) in monitoring rates for blood glucose, lipids, ECG, and TSH. Intervention rates for abnormal blood glucose and/or lipids (feedback to family doctor and/or patient, consultation to hospitalist, endocrinology, and/or dietician) did not change between 2012 and 2016.

Conclusions Electronic standardized order set can be used as a tool to improve screening for physical health comorbidity in patients with severe mental illness receiving antipsychotic medications.

From the *Department of Psychiatry, Western University, London Health Sciences Centre, London; and

Department of Psychiatry, Strathroy Middlesex General Hospital, Strathroy, ON, Canada.

Received September 7, 2017; accepted after revision June 28, 2018.

Reprints: Elyse Ross, MD, Resident Physician, Department of Psychiatry, London Health Sciences Centre–Victoria Hospital, 800 Commissioners Road E, London, ON N6A 5W9, Canada (e-mail: elyse.ross@lhsc.on.ca).

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