Impact of a nurse practitioner role on metabolic monitoring completion and referrals for consumers admitted to the intensive care area of an acute inpatient psychiatric unit

Abstract

Mental illness increases a person's risk of physical health issues, including cardiovascular disease, leading to premature morbidity and mortality. Screening for cardiovascular disease through metabolic monitoring is recommended to aid in early detection. The aim of the present study was to ascertain whether consumers admitted to an inpatient mental health unit receive routine metabolic monitoring, and to explore the contribution of a nurse practitioner to metabolic monitoring and the actioning of abnormal results. The present study used a retrospective mirror image cohort method to look at clinical consumer files for two separate 6-month periods before and after a nurse practitioner role commenced. Metabolic monitoring variables were computed as completion frequencies and percentages. Univariate analyses were computed to describe differences among metabolic monitoring variables. A total of 497 consumers were admitted to the mental health inpatient unit's intensive care area across the two 6-month data-collection periods. Prior to the nurse practitioner role, only 2% of consumers had their body mass index (BMI) risk calculated; less than 1% had their waist circumference measured, and no abnormal results were referred to a general practitioner (GP). After the nurse practitioner role commenced, BMI risk was calculated for 67% of consumers, waist circumference recorded for 68%, and referrals for abnormal results were forwarded to 37 consumers' GPs. A nurse practitioner on the inpatient mental health unit has allowed for a considerable increase in the metabolic screening of admitted consumers resulting in a number of referrals being forwarded to consumers' GPs to be acted upon.

Improving physical health outcomes for people with severe mental illness: A proof‐of‐concept study of nurse practitioner candidate practice

“…A key finding was that the presence of the NPCs in the CMHS was linked to increased detection and categorization of consumers' risk of cardiovascular diseases. These improvements in healthcare practices are consistent with those found in the only other reported study on NP-led physical health practices; however, that study was conducted in an acute inpatient mental health setting and was led by a NP, rather than a NPC (Brown et al 2018).…”

Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

“…There is a growing body of evidence supporting the role of specialist physical health clinicians in mental health services to address some physical health needs of people accessing services, especially metabolic screening and monitoring (Brown et al 2018;Druss et al 2010;Fehily et al 2017;McKenna et al 2014;Osborn et al 2010;Rogers et al 2016). There is a growing body of evidence supporting the role of specialist physical health clinicians in mental health services to address some physical health needs of people accessing services, especially metabolic screening and monitoring (Brown et al 2018;Druss et al 2010;Fehily et al 2017;McKenna et al 2014;Osborn et al 2010;Rogers et al 2016).…”

“…A variety of strategies are being explored to ensure quality physical health care is provided to people who access mental health services. There is a growing body of evidence supporting the role of specialist physical health clinicians in mental health services to address some physical health needs of people accessing services, especially metabolic screening and monitoring (Brown et al 2018;Druss et al 2010;Fehily et al 2017;McKenna et al 2014;Osborn et al 2010;Rogers et al 2016). The ability of electronic medical record systems to provide targeted prompts to clinicians to both monitor and deliver physical health interventions requires development and evaluation.…”

The adaptation and implementation of the Health Improvement Profile to Australian standards in public mental health settings

“…The organization involved in this study already has a robust metabolic monitoring policy in place, and therefore it was deliberately left out of the HIP at this stage (Brown et al, 2018).…”

“…There are many standards and guidelines across all mental health services aiming at the prevention, recognition and treatment of physical comorbidities for service users (Barnes & Psychopharmacology SCGotBAf, 2011;Stanley & Laugharne, 2014;White, Gray, Swift, Barton, & Jones, 2011). However despite this, there is evidence showing poor completion of physical health monitoring of service users in both primary and secondary care settings (Brown, McKenna, & Furness, 2018;Tosh et al, 2014;Wheeler et al, 2010). One factor thought to contribute to the poor physical health of service users is that the mental health workforce may lack the knowledge and skills to perform physical health monitoring (Wheeler et al, 2010).…”