Doctor of Nursing Practice (DNP) Projects

Access Control

Open Access

Embargo Period

4-16-2019

Degree Program

Doctor of Nursing Practice

Degree Track

Psychiatric Mental Health Nurse Practitioner (PMHNP)

Year Degree Awarded

2019

Month Degree Awarded

May

Keywords

metabolic syndrome atypical antipsychotics

Advisor

Donna Sabella

DNP Project Chair

Pamela Aselton

DNP Project Member Name

N/A

DNP Project Outside Member Name

N/A

Abstract

Atypical or second-generation antipsychotics (SGAs) are a vital part of the management of many psychotic disorders, as well as behavioral and psychological symptoms. However, these medications have serious cardiometabolic complications, such as an increase in obesity, glucose intolerance, dyslipidemia, and hypertension, and can place the patient at serious risk for cardiovascular disease. The American Diabetes Association (ADA) and the American Psychiatric Association (APA) recommend clinical guidelines for metabolic screening, which requires the regular monitoring of patients treated with SGAs (ADA, 2004). The goal of this quality improvement project was to 1) implement a metabolic screening protocol based on ADA and APA guidelines for patients admitted to an acute psychiatric hospital who were treated with second-generation antipsychotics and 2) increase healthcare personnel awareness of metabolic monitoring guidelines and metabolic syndrome. This quality improvement project was implemented at an inpatient behavioral hospital in New England. A protocol for the monitoring of metabolic disturbances was placed in thirty patients’ medical charts, who were age eighteen and over, had been prescribed SGAs, and had been taking the medication daily since the admission to the hospital. Twenty-one psychiatric mental health staff members attended the educational interventions that were conducted by the author of the project

A retrospective chart review was performed post-intervention to assess guideline adherence by comparing the percentage of tests ordered pre-intervention versus the during the post-intervention period. Data were collected over a three-month period starting from November 2018 until January 2019. The healthcare personnel awareness of metabolic monitoring guidelines and metabolic syndrome have been evaluated by a survey. After the intervention period, there were slight increases in the numbers of orders for hemoglobin A1c and lipid panel, but rates of other baseline monitoring parameters (such as weight and blood pressure) remained the same or did not improve. The waist circumference was one of the indicators that had not been measured, even after the implementation of the screening protocol.

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