Date of Conferral

8-4-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Sandra Wise

Abstract

This doctoral project was an organization change process evaluation of a quality improvement initiative in a masked outpatient mental health clinic. The practice challenge was poor metabolic monitoring and documentation among adult outpatients taking antipsychotics that were not in line with guidelines. This problem is relevant to nursing practice because use of antipsychotic medications raises risk for weight gain, dyslipidemia, hypertension, and glucose abnormalities, and not monitoring risks may delay referral or management. The practice-focused question was: According to evidence, among adult patients who are prescribed antipsychotic medications in an outpatient mental health clinic, what is the impact of implementing a standardized metabolic monitoring protocol, including workflow integration, provider education, and checklist/reminder supports, as compared to usual care, on guideline-concordant metabolic monitoring and documentation rates and timely identification/referral for metabolic abnormalities over 6 to 12 months? Data were analyzed for frequencies and percentages, pre/post comparison and run-chart review from deidentified electronic health record reports and clinic tracking data. A review of 96 pre-implementation and 104 post-implementation charts demonstrated substantial improvements. Metabolic monitoring increased from 45% to 88%, laboratory completion within 14 days improved from 50% to 86%, provider review within 7 days increased from 55% to 91%, and follow-up of abnormal results improved from 40% to 89%. The project strengthened patient safety, supported evidence-based nursing practice, and promoted better preventive cardiometabolic care for adults receiving antipsychotic treatment.

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