Metabolic Syndrome Monitoring in Patients on Depot Antipsychotics

Abstract

Aims

We conducted this audit in patients attending the Community Mental Health Team (CMHT) at St Davnet's hospital in Monaghan, County Monaghan, Ireland. The British Association for Psychopharmacology (BAP) guidelines were used for this audit to assess our service compliance with standard guidelines and to consider implementing measures to enhance the service's compliance with guidelines and maintain improvement. Metabolic syndrome (MetS) is common in patients who are prescribed depot antipsychotics. Worldwide the prevalence of MetS in Schizophrenia patients is between 30 and 40%, and MetS increases the risk of CVD and mortality. Research showed that patients with severe mental illness die 10–30 years earlier due to physical illness.

Methods

The audit cycle was from the 15th of February to the 15th of June 2022. Demographic and therapeutic variables were collected from participants within the CMHT. The action plan which included psychoeducation for nursing staff regarding guidelines for monitoring and documentation was implemented following completion of the initial audit, and then re-audited.

Results

During initial audit the sample size was 48 patients; 77% were females and 23% were males. The mean age was 54.3 years, ranging from 24 to 90 years. 39.6% of patients had MetS monitoring charts in their files, and 29.2% had completed documentation of their MetS charts. Blood pressure, lipids, and glucose were documented in 31.3%, while BMI/girth was documented in 29.2%. Paliperidone was the most common used antipsychotic (43.8%), followed by Flupentixol (31.3%), and Aripiprazole (14.6%). In re-audit the sample size was 46 patients; 76% were females and 24% were males. The mean age was 53.7 years, with the same age range as in the audit sample. MetS monitoring charts were 100% completed in all files. Glucose documentation was 95.7%, blood pressure was documented in 91.3%, BMI/girth, and lipids were documented in 87% of files. Paliperidone, Flupenthixol, and Aripiprazole were the commonly prescribed antipsychotics.

Conclusion

The implementation of the action plan resulted in recognizable improvement in MetS monitoring and documentation. To maintain this level of improvement it is essential for the CMHT to continue educating the nursing staff and other team members about the importance of MetS monitoring and documentation. Defining documentation roles and responsibilities among team members will facilitate monitoring. Identification of files that require MetS monitoring can be improved by placing colour code stickers. A MetS Clinic can be considered as a long-term plan.