Article Text

Download PDFPDF

Improving rates of metabolic monitoring on an inpatient psychiatric ward
  1. Sarah Michael1,2,
  2. Kirsty MacDonald3
  1. 1Mental Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  2. 2School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
  1. Correspondence to Dr Sarah Michael; sarah.michael1{at}


Objectives 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.

Methods 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.

Results 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.

Conclusions 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.

  • chronic disease management
  • coronary disease
  • healthcare quality improvement
  • mental health
  • nurses

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors Both authors included in this paper fulfil the criteria of authorship. In addition, we can confirm that there is no one else who fulfils the criteria but has not been included as an author. SM planned and led the intervention with assistance from KM. KM performed the audits and data evaluation. SM finalised this article with assistance from KM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained through the St Vincent’s Hospital Sydney Health, Research and Ethics Committee (reference number LNR/16/SVH/127) prior to the collection of data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.