Evaluation of a computer-based intervention to enhance metabolic monitoring in psychiatry inpatients treated with second-generation antipsychotics

Abstract

Implementation and use of an electronic pop-up alert in an inpatient psychiatric unit significantly improved rates of ordering fasting blood glucose and lipid levels for inpatients treated with SGAs. Overall rates remain suboptimal, suggesting a need for additional strategies to further improve metabolic monitoring.

Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention

“…Instead, this could indicate a decline in the effectiveness of the alert to trigger ordering of these laboratory parameters. The potential confounder of having a psychiatric pharmacist provides verbal reminders to prescribers (physicians or nurse practitioners) on the unit was consistent during both study periods, and this, as well as other study limitations have previously been described . In all, whereas the results of the study supported the long‐term impact of the pop‐up alert in maintaining the rates of monitoring, additional steps are still needed to increase the percentage of inpatients who have fasting glucose levels and lipid panels available while receiving SGAs.…”

“…Despite increased awareness and general acceptance of these guidelines, appropriate metabolic monitoring has remained uncommon. In fact, several studies concluded that the publication of these guidelines in 2004 did not increase metabolic testing in patients initiating SGA therapy . One reason for this may be the uncertainty regarding the role of psychiatrists in directly managing metabolic abnormalities themselves.…”

“…In response to the suboptimal metabolic monitoring of patients on SGAs, a study conducted by DelMonte et al . evaluated the efficacy of a computerized physician order entry (CPOE) pop‐up alert designed to improve rates of laboratory metabolic monitoring of patients treated with SGAs at a large Midwestern academic medical centre's inpatient psychiatry unit.…”

A Randomized Controlled Trial of a Patient-Centered Approach to Improve Screening for the Metabolic Side Effects of Antipsychotic Medications

“…A number of programs to improve monitoring for the metabolic adverse effects of antipsychotic medications that go beyond passive dissemination of guidelines have been described (Barnes et al 2008; Schneiderhan et al 2009; Nicol et al 2011; Thompson et al 2011; DelMonte et al 2012; Ramanuj 2013; Velligan et al 2013). These programs included interventions for clinicians or clinics comprised of one, and often multiple, components including educational sessions (Barnes et al 2008; Nicol et al 2011; Thompson et al 2011; Ramanuj 2013; Velligan et al 2013), posting of printed educational materials (Barnes et al 2008; Thompson et al 2011; Ramanuj 2013), audit and feedback on monitoring practices (Barnes et al 2008; Nicol et al 2011; Ramanuj 2013), paper reminders about monitoring placed in medical charts (Nicol et al 2011; Thompson et al 2011), computerized reminders about monitoring at the time of antipsychotic prescribing (DelMonte et al 2012), and provision of implementation tools (e.g., monitoring equipment) (Thompson et al 2011) and other delivery system and procedural interventions (e.g., hiring of a medical assistant charged with ensuring labs were drawn and results presented on a metabolic tracking form, implementation of a pharmacist or nurse-led metabolic monitoring clinic) (Schneiderhan et al 2009; Velligan et al 2013).…”

“…These programs included interventions for clinicians or clinics comprised of one, and often multiple, components including educational sessions (Barnes et al 2008; Nicol et al 2011; Thompson et al 2011; Ramanuj 2013; Velligan et al 2013), posting of printed educational materials (Barnes et al 2008; Thompson et al 2011; Ramanuj 2013), audit and feedback on monitoring practices (Barnes et al 2008; Nicol et al 2011; Ramanuj 2013), paper reminders about monitoring placed in medical charts (Nicol et al 2011; Thompson et al 2011), computerized reminders about monitoring at the time of antipsychotic prescribing (DelMonte et al 2012), and provision of implementation tools (e.g., monitoring equipment) (Thompson et al 2011) and other delivery system and procedural interventions (e.g., hiring of a medical assistant charged with ensuring labs were drawn and results presented on a metabolic tracking form, implementation of a pharmacist or nurse-led metabolic monitoring clinic) (Schneiderhan et al 2009; Velligan et al 2013). Although shown to be effective in increasing rates of metabolic monitoring, these interventions consisted predominately of quality improvement programs evaluated with non-randomized designs in small samples, only some of which included comparison groups (Nicol et al 2011; DelMonte et al 2012; Velligan et al 2013). In addition, none of these interventions targeted individuals with serious mental illness as potential agents of change in improving rates of metabolic monitoring within a patient-centered care framework.…”