Background Significant side effects, including weight gain, hyperglycemia, hyperlipidemia and tardive dyskinesia may occur with the use of antipsychotic medications, particularly with long term use in pediatric patients. An antipsychotic medication safety project was developed to monitor these side effects to improve the safety of antipsychotic treatment.

Objectives The aim was to increase compliance with the antipsychotic medication monitoring protocol in patients seen during outpatient psychiatry visits for ongoing care from 48% in 1st quarter 2012 to 85% by 4th quarter 2013 and sustain for 2 years.

Methods A multidisciplinary team established a side effect monitoring protocol for all pediatric patients receiving antipsychotic medications for more than 30 days. The monitoring protocol consisted of 8 elements such as lipid profiles, BMI and documentation of vitals in EMR. The QI team developed key drivers and implemented interventions, such as best practice alerts in EMR. Adherence to the protocol was measured by sampling medical records and auditing compliance to all 8 elements. Detailed chart audit results were provided to the providers quarterly to improve compliance.

Results By 4th quarter 2013, protocol compliance increased from 48% to 85% and with quarterly feedback and support, the outpatient psychiatry team was able to sustain 85% compliance for the past two years.

Conclusions We have achieved a reliable system for monitoring the use of antipsychotic medication, which has since been spread to other disciplines such as Autism and Developmental Disabilities resulting in the majority of patients being monitored for antipsychotic medication safety and has also resulted in patient care standardization.⇓

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Figure 1

Antipsychotic Medication Safety Compliance.