Program Evaluation of a Quality Improvement Intervention to Increase Provider Adherence to National Guidelines for Metabolic Monitoring in Psychiatric Patients

Abstract
Aim: This was a formal evaluation of a quality improvement project that was implemented at a University Health System inpatient psychiatry unit between 2017 and 2019. The project goal was to increase provider adherence to the ADA/APA 2004 Guidelines for metabolic monitoring.

Method: The Centers for Disease Control framework for program evaluation was used. Based on stakeholder feedback, five questions were answered. Reports from the University Health System data analytics, a Qualtrics survey and quantitative analysis were employed.

Results: 1. Personal reminders by an inpatient pharmacist increased rates of metabolic monitoring from 40% to 76%. Implementation of a computer “smart” rule further increased rates to 89%. 2. After 11 months, there was no statistical difference in lipid testing between the pharmacist reminders and the computer smart rule (p = .098, 95% CI -28.50 to 1.98). Rates were maintained with less monthly variability and with less intervention from the pharmacist after the rule was implemented. 3. The smart rule was found to fire repeatedly until a provider ordered the metabolic labs 4. Lipid testing was the least ordered component of the metabolic panel. Qualtrics survey (n=22) showed providers were aware of the guidelines (95%) and agreed with them (75%). They believed the smart rule was a facilitator to adherence (85%).
5. Nurses were able to obtain 94% of labs ordered before patient discharge.

Implication: An automated computer smart rule was able to sustain and improve upon rates of provider compliance with guidelines for metabolic monitoring. This allowed reduced interventions by the inpatient pharmacist.