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

Geen, Jessica, Nursing Practice - School of Nursing, University of Virginia
Wiencek, Clareen, School of Nursing, University of Virginia

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.

DNP (Doctor of Nursing Practice)
metabolic, guidelines, psychiatric, inpatient
All rights reserved (no additional license for public reuse)
Issued Date: