Title of the Change Project Student ID. MSc in Healthcare Management, Institute of Leadership, Royal College of Surgeons in Ireland Header line 1 Header line 2 Header line 3 Establishing a Physical Health Monitoring Service for Patients on Depot Antipsychotic Medication Melissa Gill, RCSI Institute of Leadership Abstract This quality initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication. Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. For the purpose of this project, a subgroup of such patients, prescribed antipsychotics in long-acting injectable (depot) form, was chosen. The HSE change model was utilised to guide the change. A twice-yearly, multidisciplinary monitoring clinic was established and its implementation is described. A protocol was drawn up, with reference to current international guidelines, and a unique proforma assisted as an aide memoire. Evaluation took place in descriptive form with audit used to examine outcomes. Improvements were noted in blood test recording and measurement of physical parameters. Systematic enquiry was made into medication side effects with the help of a standardised questionnaire. The clinic was well-received and led to improved quality of teamwork. Future recommendations include organising the clinic in such a way as to include simultaneous blood testing. As a result of the increased focus on physical health monitoring, a similar service is being planned to target all patients attending the service who are prescribed antipsychotics.

Establishing a Physical Health Monitoring Service for Patients on Depot Antipsychotic Medication Melissa Gill, RCSI Institute of Leadership Introduction & Background Methodology Evaluation It has been recognised for many years that patients with severe mental illness are at dramatically increased risk of premature death1,2. An audit in the author’s organisation indicated that physical health monitoring was falling below best practice guidelines. A quality initiative targeting monitoring of the physical health of patients on long-acting injectable (depot) antipsychotics was proposed. The HSE change model was chosen to guide the project. Initiation Local, national and international imperative for change helped create a sense of urgency. Planning Relentless communication to the community mental health nurses and psychiatrists needed to staff the team meant that resistance was remarkably low. This was helped by a value-driven, patient-centred culture present within the service. Implementation 23 patients were identified as receiving depot antipsychotics. A twice-yearly multidisciplinary clinic was established where patients: Mainstreaming Commitment from the team should ensure the clinics continue. Embedding it in the routine review clinic structure has helped make it part of “the way we do business”3. A combination of descriptive and audit methods showed: Clinics ran smoothly, with positive feedback from patients and staff. Blood test and physical parameter monitoring improved as shown: Figure 2: Improvements in blood monitoring Reasons include: Higher smoking rates Poor nutrition ↑ risk of diabetes Less likely to access healthcare Meds can ↑ metabolic syndrome Figure 1: HSE Change Model 3 Figure 3: Improvements in physical parameter monitoring Organisational Impact The project stimulated interest locally in expanding a similar monitoring service to all patients prescribed antipsychotics. The author has been co-opted onto a committee to help develop this. Aims & Objectives The project aimed to improve the physical health monitoring of patients receiving antipsychotic medication in depot formulation . Conclusion Objectives: Establishment of a register of all patients on depot antipsychotics All patients will have had: Blood monitoring done in the past year Physical parameters (weight, BMI, waist circumference and BP) checked in the past year Documentation of enquiry into side effects in past year Documentation of rationale for polypharmacy, if present Have physical parameters checked Have a psychiatric review Complete a side effect questionnaire Are given blood forms for the local phlebotomy clinic This service development project improved the quality of physical health monitoring in patients prescribed depot antipsychotics. The process helped build teamwork. Further challenges in rolling out the project to a wider group are welcomed. References 1. Fazel S, Wolf A, Palm C, Lichtenstein P. Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden. Lancet Psych. 2014; 1(1):44-54. 2. Harris E, Barraclough B. Excess mortality of mental disorder. Br J Psych. 1998; 173:11-53. 3. Health Service Executive. Improving Our Services: A Users’ Guide to Managing Change in the Health Service Executive. Dublin: HSE, 2008.