Metabolic monitoring of pediatric patients prescribed second-generation antipsychotic medication

Julie Henshaw Roebuck DNP, APRN, PMHNP-BC
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Abstract

Introduction

The prevalence of psychotropic medication prescription use in youth has increased over the past several years. Despite recommendations and practice parameters established by the American Diabetes Association-American Psychiatric Association (ADA-APA) outlining metabolic monitoring of patients prescribed second-generation antipsychotic (SGA) medication, monitoring adherence for the pediatric patient population remains inadequate.

Aims

This project aimed to improve metabolic monitoring of pediatric patients prescribed SGAs and discharge recommendations for follow-up monitoring within a small, child, and adolescent psychiatric hospital.

Methods

This project compared metabolic monitoring adherence rates pre and postimplementation of a metabolic monitoring organizational policy developed to provide procedural guidance, using ADA-APA guidelines. Participants included prescribing clinicians (physicians and psychiatric nurse practitioners).

Results

Phase 1 chart reviews found no records of fasting blood glucose, fasting lipid profile or waist circumference. Following project implementation, chart review found that fasting blood glucose and fasting lipid profile was recorded in 21 (72.4%) of the charts, and waist circumference was recorded in 18 (62.1%) of the charts for patients prescribed SGA medication. For patients discharged on an SGA, written recommendations for follow-up metabolic monitoring improved from 13% to 70% (<0.001).

Conclusions

Implementing an organizational metabolic monitoring policy and protocol can improve clinician adherence to ADA-APA guidelines for recording in-patient monitoring of metabolic parameters and discharge recommendations for pediatric patients prescribed SGA medication.

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对服用第二代抗精神病药物的儿科患者进行代谢监测
导言:在过去几年中,青少年精神药物处方使用率有所上升。尽管美国糖尿病协会-美国精神病学协会(ADA-APA)提出了对开具第二代抗精神病药物(SGA)的患者进行代谢监测的建议和实践参数,但对儿科患者的监测仍然不足。 目的 本项目旨在改善对开具 SGA 药物的儿科患者的代谢监测,并对一家小型儿童和青少年精神病医院的出院随访监测提出建议。 方法 本项目比较了采用 ADA-APA 指南制定代谢监测组织政策以提供程序指导前后的代谢监测依从率。参与者包括开处方的临床医生(医生和精神科执业护士)。 结果 第一阶段的病历审查没有发现空腹血糖、空腹血脂或腰围记录。项目实施后,病历审查发现,在 21 份(72.4%)病历中记录了空腹血糖和空腹血脂,在 18 份(62.1%)病历中记录了开具 SGA 药物的患者的腰围。对于服用 SGA 出院的患者,书面建议进行后续代谢监测的比例从 13% 提高到 70% (<0.001)。 结论 实施组织代谢监测政策和方案可提高临床医生对 ADA-APA 指南的遵守程度,以记录住院患者的代谢参数监测情况,并为开具 SGA 药物的儿科患者提供出院建议。
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来源期刊
CiteScore
2.90
自引率
6.70%
发文量
41
期刊介绍: Journal of Child and Adolescent Psychiatric Nursing (JCAPN) is the only nursing journal to focus exclusively on issues of child and adolescent mental health around the world. As a primary resource for nurses and other healthcare professionals in clinical practice, educator roles, and those conducting research in mental health and psychiatric care, the journal includes peer-reviewed, original articles from a wide range of contributors in a broad variety of settings.
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