Metabolic monitoring among patients with psychotic disorders taking antipsychotics: results of a quality improvement project to address this challenging guideline-practice gap.

Background: Metabolic adverse effects of antipsychotic medications pose significant health risks for patients with psychotic disorders. Despite clinical practice guidelines recommending regular metabolic monitoring, adherence to these recommendations remains suboptimal in psychiatric settings.

Objective: This quality improvement project aimed to assess the impact of an organisational paper-based metabolic monitoring form (MMF) on monitoring practices for patients with psychotic disorders receiving antipsychotic medications at an outpatient psychiatric clinic in a large Canadian city.

Methods: A pre-post intervention study was carried out to assess the impact of the MMF on annual monitoring among 75 randomly selected eligible patients. Metabolic monitoring parameters (blood pressure, weight, waist circumference and glucose and lipid profiles) were reviewed 1 year before and after the introduction of the form.

Results: The MMF was missing from 10 charts, and despite its presence in the remainder, no improvement was observed in metabolic parameter documentation, and overall guideline adherence remained low. Fasting glucose and HbA1c measurements were most frequently ordered, while blood pressure and weight measurements remained consistently low across both periods.

Conclusions: The implementation of a paper-based MMF alone was insufficient to bridge the guideline-practice gap in metabolic monitoring, highlighting the need for other or concurrent strategies to achieve improvement.