Mental Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
School of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
BMJ Open Qual. 2020 Jul;9(3). doi: 10.1136/bmjoq-2019-000748.
Cardiovascular disease is the leading cause of premature death in patients with mental illness. Metabolic syndrome is a cluster of co-occurring cardiovascular risk factors, seen in high frequency in severe mental illness. Despite ease of diagnosis, monitoring is often poor across psychiatric populations. This report details a quality improvement initiative undertaken on an inpatient psychiatric ward to improve rates of metabolic monitoring.
Four key interventions were developed: (1) A nurse-led intervention, where nurses were upskilled in performing metabolic monitoring, (2) Education was provided to all staff, (3) Introduction of a suite of interventions to improve metabolic risk and (4) Ongoing consumer involvement. A pre-post intervention study design was used to measure effectiveness, with an audit of metabolic monitoring rates performed 12 months after the intervention began.
Rates of weight and height monitoring both increased from 46.0% to 69.5% (p=0.0185) and body mass index (BMI) recordings increased from 33% to 63% (p=0.0031). Rates of waist circumference monitoring increased from 44.2% to 65.2% (p=0.0498). Blood pressure (BP) measurements increased from 88.5% to 100% (p=0.0188). Lipid monitoring rates improved from 23% to 69.5% (p=0.001). Rates of glucose monitoring increased from 74% to 82.5% (p=0.8256), although this was not statistically significant.
We found that metabolic monitoring improved following these simple interventions, with a statistically significant increase in measurement rates of weight, BP, height, lipids, BMI and waist circumference (p<0.05). Overall monitoring of glucose also improved, although not to significant levels. The intervention was acceptable to both patients and staff.
心血管疾病是精神疾病患者早逝的主要原因。代谢综合征是一组同时发生的心血管危险因素，在严重精神疾病中高频出现。尽管诊断容易，但在精神科人群中监测通常不佳。本报告详细介绍了在精神病住院病房进行的一项质量改进计划，以提高代谢监测率。
开发了四项关键干预措施：（1）护士主导的干预，培训护士进行代谢监测；（2）向所有员工提供教育；（3）引入一系列干预措施以改善代谢风险；（4）持续的消费者参与。采用前后干预研究设计来衡量效果，在干预开始后 12 个月进行代谢监测率的审核。
体重和身高监测率均从 46.0%增加到 69.5%（p=0.0185），体重指数（BMI）记录率从 33%增加到 63%（p=0.0031）。腰围监测率从 44.2%增加到 65.2%（p=0.0498）。血压（BP）测量率从 88.5%增加到 100%（p=0.0188）。血脂监测率从 23%提高到 69.5%（p=0.001）。血糖监测率从 74%提高到 82.5%（p=0.8256），尽管这在统计学上并不显著。
我们发现，这些简单的干预措施后代谢监测得到了改善，体重、BP、身高、血脂、BMI 和腰围的测量率有统计学显著增加（p<0.05）。葡萄糖的总体监测也有所改善，尽管未达到显著水平。该干预措施得到了患者和员工的认可。
