SOP 508.24-att-8: Instructions for Completing Antipsychotic Weight & Waist Record (M60-01-08)

SOP 508.24
Attachment 8

8/15/22
# Instruction Guidelines for Completing Antipsychotic Weight & Waist Record

1. BLOOD LABS - Required blood labs for monitoring all antipsychotics will be ordered,

followed and documented just like those for valproic acid, carbamazepine and lithium. The
psychiatrist will order the labs, then sign the lab sheets when they are reviewed and document
the results in the progress note as appropriate.
2. WEIGHT/WAIST - The psychiatrist/CNS and MH nursing staff will work together to find the

most practical, efficient method of collecting the required weight and waist measurements.

a. In most clinics where the psychiatrist has a consistent office space that would

accommodate a body weight scale, it will generally be recommended that the
psychiatrist gather the body weight and waist measurements.
b. In some clinics or situations where it is not practical for the psychiatrist, the nurse will

gather body weight and waist measurements.
c. The gathering and/or ordering, as well as the assessment of these measurements is the

responsibility of the physician. If the physician is not able to gather the measurement the
physician has the responsibility to make arrangements to have the nurse do it, either by prior
agreement or by a physician’s order.

* The Antipsychotic Weight & Waist Record will be kept in Section 5 of the Medical Chart . No copy
is needed in the mental health chart.

* The reason for having a weight and waist measurement flow sheet is to enable the mental health team
to have a single place to put these measurements so that teams of doctors and nurses will always know
where to go to see if the required measurements are being drawn. This will be especially important
when a patient may be in one setting at a facility where the decision is that the nurse will do both
weight and waist yet when the patient moves to another setting at that facility where it has been decided
that the doctor will gather and document weight and waist there will be a consistent place to keep
the data.

* Body weight will be gathered a minimum of every 3 months. If more frequent monitoring is thought
to be necessary, either have it done in your clinic or teach and recommend self-monitoring of weight
between clinic visits.

* While BMI is still a very useful way of assessing and following weight, it has been decided that it is
more common and more practical for us to use weight in pounds ( lbs. ).

* Weight and waist measurements will be taken on all patients taking antipsychotics; atypical and
typical. Since many patients may switch back and forth and have variable compliance with treatment,
it is more practical to simply keep an ongoing record of weight and waist measurements with the
purpose of helping the patient monitor for possible side effects of their medication.

*REMINDER. We are required to monitor the following labs at a minimum (See SOP for full detail):

|MEDICATION|INITIATING|MAINTENANCE|Col4|
|---|---|---|---|
|LITHIUM|CBC, BUN, CREAT, LYTES,
TSH (or TFT), U/A, HcG♀,
level
at 7 days, ECG (OLDER THAN 45)|Q 6 MONTH-
BUN, Creat, lytes
TFT|
YEARLY- same as initial and
lithium level
*Level W/I 7 days of dose change|
|CARBAMAZEPINE|CBC, HcG♀, LFT (AST), Bld level
monthly for 2 Mo|Q 6 MONTH- Bld. level|Q 6 MONTH- Bld. level|
|VALPROIC ACID|CBC, HcG♀, LFT (AST)|Repeat initial testing at 6 months|Repeat initial testing at 6 months|
|ANTIPSYCHOTICS|
Waist, Weight, BP, FBS,
HgA1C, Lipid panel
Repeat all one quarter after initiating
Rx|QUARTERLY-
Weight, BP, FBS,
HgA1C, Lipid
panel|
YEARLY-Waist, Weight, BP,
FBS, HgA1C, **Lipid Panel
yearly only if abnormal otherwise
every 5 years.|

Retention Schedule: The instructions are to be utilized until revised or obsolete.