Studies delivering high-quality care at a time of such

Studies have shown that quality
improvement approaches can be adopted in health care to improve processes of
care. The health care system faces challenges in delivering high-quality care
at 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 exclusively
from large-scale reforms or from the ‘top-down’ imposition of new initiatives,
or even from external forces such as inspection and regulation (Ham, 2014). Changes
can only be effective if used in combination with a focus on ‘reform from
within’, built on an understanding that those closest to quality problems are
often best placed to find the solutions (Ross and Naylor, 2017). There is a
pressing need to improve quality in mental health care services. Many studies
have indicated that there is potential to enhance service users’ experience and
improve 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 a
service user experiencing a relapse in their mental health who was admitted to
the inpatient unit and had previously attended her GP and outpatient’s
appointments in primary care and (B) the author will discuss how to implement and
electronic screening for metabolic syndrome within the service user’s journey.

Statistical summaries of the
excess morbidity and mortality among people with severe and enduring mental
illness (SEMI) are stark reminders that health inequalities persist within
countries (DeHert et al., 2011). Although life expectancy generally has
increased steadily over the past century, no such gains have occurred among
people with SEMI. Life expectancy of people with SEMI is around 20% shorter
than the general population, the majority of which is caused by treatable
physical illnesses including cardiovascular disease which the leading cause of
pre-mature death in people with SEMI (Young et al., 2017). One of the most growing
physical health concerns in mental health is the high incidence of Metabolic
Syndrome (MetS), a well-known cluster of inter-related risk factors associated
with type 2 diabetes, cardiovascular disease and stroke. The clinical value of
the syndrome is well established, yet only a small number of patients are
regularly screened for the key characteristics of central obesity, glucose
intolerance/insulin resistance, hypertension and dyslipidaemia (Stanley, 2016).
Monitoring markers of metabolic syndrome is particularly crucial in mental
health services since anti-psychotic medication used is associated with a
higher prevalence of MetS (McDaid and Smyth, 2015). Mental health services have
an important role in establishing an accurate rate of MetS of people with SEMI
and applying that information for prevention and effective management of
cardiovascular disease and diabetes (Stanley & Laugharne, 2011). However, research
in mental health services used to estimate the prevalence of MetS is disparate
and metabolic monitoring is below the levels required for effective care (Cotes
et al., 2015).

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Mary a thirty-five year old lady,
with a long standing diagnosis of schizoaffective disorder was admitted to the
acute 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 been
carried out by her GP in collaboration with the mental health services in
primary care. Mary met some of the criteria to be screened for MetS as she
presented as overweight and was also prescribed regular anti-psychotics,
however she was never screened for MetS at any stage of her journey through the
mental health services. The importance and consequence for mental health
services is that rates of MetS in populations with SEMI surpass general
population rates. An Irish study by O?Brien et al (2007) found that 40.7% of
people with SEMI fulfilled criteria for MetS in comparison to 20.7% of the
general population while internationally Hausswolff-Juhlin et al. (2009) found
rates of 27% in the general population rising to approximately 40–60% in an
overall SEMI population.  

When attending her GP or mental
health services outpatient’s appointments in primary care Mary reported to not
having her blood pressure, weight or BMI checked regularly and was never screened
for diabetes or dyslipidaemia. A study by Roberts et al. (2007) examined the
prevalence of routine health checks in primary care of people with
schizophrenia in comparison to a control group of asthma patients. Results
indicated that people with a diagnosis of schizophrenia were less likely to
have blood pressure checks, 55.9% compared to Asthma 71%, weight recorded,
39.5% compared to Asthma 46.4%, and cholesterol, 12.3% compared to Asthma
21.8%. People with schizophrenia were also less likely to have these standard
health checks in comparison to the general population albeit to a lesser
extent. McDonald (2008) explored the views and practices of Community Mental
Health Nurses(CMHNs) in relation to metabolic syndrome. Three themes emerged
from the data which were concerns, CMHN practices and barriers to care.
Although concerned about the physical health of service users the CMHNs stated
they were unable to expand their practice due to large caseloads and lack of
resources. Regarding current practices of screening, the results indicated that
screening was haphazard and inconsistent as it is not performed routinely and nil
protocols are in place. There is uncertainty among healthcare professionals as
to whether such physical health screening was the responsibility of the
psychiatric team rather than a primary care clinician.