Improvement of Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program Measure: Screening for Metabolic Disorders (SMD) through pharmacy collaborative practice agreement

Abstract: Background Second-generation antipsychotics are associated with lower risks of extrapyramidal symptoms including tardive dyskinesia. However, many second-generation antipsychotics are associated with significant metabolic side effects including weight gain, impaired glucose control, and hyperlipidemia. Metabolic monitoring for patients prescribed antipsychotic medication is one of several measures of the Center for Medicare & Medicaid Services' Inpatient Psychiatric Facility Quality Reporting Program. Screening for Metabolic Disorders (SMD) must be obtained within the previous 365 days prior to the hospital discharge date. National data suggest compliance with this measure is low. Objective To improve compliance of metabolic monitoring by 20% while assuring that quality improvement interventions did not cause any unintended, adverse effects on other aspects of our system. Practice Description This quality initiative was conducted at a large 2,000 bed academic medical center with approximately 80 inpatient psychiatric beds. Practice innovation To improve the metabolic screening rates, a pharmacist Collaborative Practice Agreement (CPA) was established as a part of a quality improvement project. Previously, there were no formal processes at the institution to ensure appropriate laboratory tests were drawn. Evaluation methods Using an uncontrolled before and after design, SMD data were gathered from 6 months prior to and 6 months following CPA implementation. Pearson's chi-squared test or Fisher's Exact Test were used to compare pre- and post-intervention groups in this quasi-experimental design. Results Compared to the pre-intervention period, compliance to SMD monitoring increased by 21.2% in the post-intervention phase - from 69.2% to 90.4% (p Conclusion Empowerment of clinical pharmacists with a CPA significantly improved guideline-concordant metabolic monitoring of antipsychotics. These findings may have significant impact on the approach to the safe use of these essential psychotropic medications and provide a framework for other inpatient mental health facilities to optimally utilize the skills of their interdisciplinary team.