Studies have shown that qualityimprovement approaches can be adopted in health care to improve processes ofcare. The health care system faces challenges in delivering high-quality careat a time of such financial restrictions and workforce shortages (Dunn et al.,2016).
It has been argued that the solutions for such challenges will not come exclusivelyfrom large-scale reforms or from the ‘top-down’ imposition of new initiatives,or even from external forces such as inspection and regulation (Ham, 2014). Changescan only be effective if used in combination with a focus on ‘reform fromwithin’, built on an understanding that those closest to quality problems areoften best placed to find the solutions (Ross and Naylor, 2017). There is apressing need to improve quality in mental health care services. Many studieshave indicated that there is potential to enhance service users’ experience andimprove outcomes by using a quality improvement approach in mental health care(Abdallah et al., 2016). Throughout this assignment the author will discuss (A)the opportunities for improving quality and safety in metabolic screening for aservice user experiencing a relapse in their mental health who was admitted tothe inpatient unit and had previously attended her GP and outpatient’sappointments in primary care and (B) the author will discuss how to implement andelectronic screening for metabolic syndrome within the service user’s journey.
Statistical summaries of theexcess morbidity and mortality among people with severe and enduring mentalillness (SEMI) are stark reminders that health inequalities persist withincountries (DeHert et al., 2011). Although life expectancy generally hasincreased steadily over the past century, no such gains have occurred amongpeople with SEMI.
Life expectancy of people with SEMI is around 20% shorterthan the general population, the majority of which is caused by treatablephysical illnesses including cardiovascular disease which the leading cause ofpre-mature death in people with SEMI (Young et al., 2017). One of the most growingphysical health concerns in mental health is the high incidence of MetabolicSyndrome (MetS), a well-known cluster of inter-related risk factors associatedwith type 2 diabetes, cardiovascular disease and stroke. The clinical value ofthe syndrome is well established, yet only a small number of patients areregularly screened for the key characteristics of central obesity, glucoseintolerance/insulin resistance, hypertension and dyslipidaemia (Stanley, 2016).Monitoring markers of metabolic syndrome is particularly crucial in mentalhealth services since anti-psychotic medication used is associated with ahigher prevalence of MetS (McDaid and Smyth, 2015). Mental health services havean important role in establishing an accurate rate of MetS of people with SEMIand applying that information for prevention and effective management ofcardiovascular disease and diabetes (Stanley & Laugharne, 2011).
However, researchin mental health services used to estimate the prevalence of MetS is disparateand metabolic monitoring is below the levels required for effective care (Coteset al., 2015).Mary a thirty-five year old lady,with a long standing diagnosis of schizoaffective disorder was admitted to theacute unit from the community undergoing a relapse in her mental health.
Previous to this Mary had been well for many years and her care had beencarried out by her GP in collaboration with the mental health services inprimary care. Mary met some of the criteria to be screened for MetS as shepresented as overweight and was also prescribed regular anti-psychotics,however she was never screened for MetS at any stage of her journey through themental health services. The importance and consequence for mental healthservices is that rates of MetS in populations with SEMI surpass generalpopulation rates. An Irish study by O?Brien et al (2007) found that 40.7% ofpeople with SEMI fulfilled criteria for MetS in comparison to 20.7% of thegeneral population while internationally Hausswolff-Juhlin et al.
(2009) foundrates of 27% in the general population rising to approximately 40–60% in anoverall SEMI population. When attending her GP or mentalhealth services outpatient’s appointments in primary care Mary reported to nothaving her blood pressure, weight or BMI checked regularly and was never screenedfor diabetes or dyslipidaemia. A study by Roberts et al.
(2007) examined theprevalence of routine health checks in primary care of people withschizophrenia in comparison to a control group of asthma patients. Resultsindicated that people with a diagnosis of schizophrenia were less likely tohave blood pressure checks, 55.9% compared to Asthma 71%, weight recorded,39.
5% compared to Asthma 46.4%, and cholesterol, 12.3% compared to Asthma21.8%. People with schizophrenia were also less likely to have these standardhealth checks in comparison to the general population albeit to a lesserextent.
McDonald (2008) explored the views and practices of Community MentalHealth Nurses(CMHNs) in relation to metabolic syndrome. Three themes emergedfrom the data which were concerns, CMHN practices and barriers to care.Although concerned about the physical health of service users the CMHNs statedthey were unable to expand their practice due to large caseloads and lack ofresources. Regarding current practices of screening, the results indicated thatscreening was haphazard and inconsistent as it is not performed routinely and nilprotocols are in place. There is uncertainty among healthcare professionals asto whether such physical health screening was the responsibility of thepsychiatric team rather than a primary care clinician.