Development and evaluation of a physical health monitoring service for people prescribed psychotropic medications
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Authors
vanTonder, Debbie
Moloney, Catherine
Maher, Tom
Donohue, Gráinne
Issue Date
2025-11-07
Type
Article
Language
en
Keywords
Alternative Title
Abstract
Background/aims: Effective monitoring enables preventive care and early intervention
for individuals with severe mental illness on psychotropic medications. St Patrick’s
Mental Health Service established a multidisciplinary physical health monitoring
programme, combining psychiatry and nursing expertise to ensure continuous
surveillance. This article outlines the service’s development, implementation and
evaluation of adherence rates.
Methods: The Health Service Executive model of improvement was used to develop
and implement the physical health monitoring service. A monthly audit was conducted
to collect and assess physical health monitoring data from electronic health records
of service users aged between 12–82 years. A total of 1827 inpatient electronic health
records were reviewed from January–December 2024.
Results: Adherence to physical health monitoring standards were generally high across
all five medications in the initial audit. Clozapine demonstrated the most complete
compliance, with mostly 100% adherence rate. In contrast, quetiapine and olanzapine
exhibited greater variability, particularly in electrocardiogram monitoring, where
adherence ranged from 87% to 100%, and body mass index measurement, which
ranged from 72% to 100%. Among mood stabilisers, sodium valproate achieved 100%
overall adherence, with one instance of reduced compliance (90%). Lithium monitoring
showed minor inconsistencies, with electrocardiogram and body mass index adherence
raging at 92% to 100% and serum lithium ranging around 95% but overall achieving
100% adherence.
Conclusions: Challenges around implementation of the service demonstrated the
importance of clear communication and collaborative stakeholder involvement during
all phases of the new initiative. Responsive leadership allowed the management team
and the physical health monitoring clinicians to address adaptive problems by exploring
concerns in a supportive and collaborative way. Technical problems were addressed
and resolved through updated policies and procedures clarifying changes and managing
expectations. The data on adherence rates highlighted ongoing challenges to achieve
consistency in completing 100% adherence. Overall, the implementation of a physical
health monitoring service improved early detection of outstanding physical healthcare
requirements. Additionally, ongoing regular surveillance enabled early identification of
compliance gaps, allowing for prompt corrective actions by healthcare staff, ensuring the
highest standards of patient safety and individualised care.
Implications for practice: This study could inform further development of physical
health monitoring services in mental health settings, particularly the use of ongoing
monitoring to facilitate improvements and enhancements in practice. Future service
developments should encourage and promote continuous training for mental health
nurses to minimise inconsistent monitoring among service users. This will improve the
impact of the service and ensure adherence to monitoring standards.
Description
Citation
van Tonder D, Moloney C, Maher, T, Donohue G. (2025) Development and evaluation of a physical health monitoring service for users prescribed psychotropic medications. British Journal of Mental Health Nursing, https://doi. org/10.12968/bjmh.2025.0012