Development and evaluation of a physical health monitoring service for people prescribed psychotropic medications

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.