It is important to monitor not only metabolic parameters but also lifestyle and psychosocial parameters in people under our care. Lifestyle parameters, as well as the use of substances can affect metabolic measures in people receiving our care. Unfortunately more time is spent on identifying metabolic parameters. Increased identification of maladaptive lifestyle factors like binge eating when stressed, being idle, choosing more fatty food, and refusing to have regular GP reviews and regular monitoring of antipsychotic specific side effects will help in improving the health of our consumers in a holistic manner.
It would be good to understand the factors contributing towards these maladaptive factors and develop a good intervention for the service in future. A continuous service improvement project, incorporating a Plan Do Study Act (PDSA) cycle approach, is required to improve the measuring and monitoring of metabolic, psychosocial and lifestyle parameters in people receiving antipsychotics at The Cottage. It is proposed that this project would:
– include a qualitative survey to collect information that will inform the creation of a system for collecting and presenting this information so that clinicians can have a quick overview of the patient’s health to guide discussions with the patient (`intervention’).
– incorporate using MDT meetings to identify what information is gathered about the specific service user’s lifestyle factors and how it can be used to support the service user. The MDT role would fit well with this as part of an improvement project
– link to the Equally Well initiative
– incorporate a service user self-management approach to lifestyle issues and as part of developing effective support. A consumer engagement advisor from the Consumer and Family/Whaanau Centred Care team could help The Cottage develop more collaboration with service users on this
– and result in the development of an intervention. Possible interventions could include development of a routine `screening’ form for keyworkers and doctors to complete that will auto-populate in HCC, and a click point on HCC to bring this information up. It might be that we expand the metabolic form we already have in HCC – to include Lifestyle – including diet and activity levels, GP attendance, CVD risk proforma from Primary care. The intervention will then be tested as part of a PDSA cycle.
The first step is to conduct a case series review to provide baseline audit. We have got approval to do the audit now from the MHRG.
We are planning to do a manual review of clinical notes of a randomised sample of 10 clients in the service for the last 6 months now.
Venkat Krishnamurthy Naga
Counties Manukau Health