SOP_NUMBER: 508.24-att-8 TITLE: Instructions for Completing Antipsychotic Weight & Waist Record (M60-01-08) DIVISION: Mental Health TOPIC_AREA: 508 Policy-MH Evaluations/Screenings/Treatment EFFECTIVE_DATE: 2022-08-15 WORD_COUNT: 616 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/366920 URL: https://gps.press/sop-data/508.24-att-8/ SUMMARY: This form provides instructions for mental health clinical staff on how to monitor and document weight and waist measurements for inmates taking antipsychotic medications. The psychiatrist or certified nursing specialist is responsible for ordering measurements and arranging for their collection, with measurements to be recorded in a standardized flow sheet kept in the medical chart. Weight and waist measurements must be taken at minimum every three months for all patients on antipsychotics, along with required blood labs including fasting blood sugar, hemoglobin A1C, lipid panel, and blood pressure monitoring. KEY_TOPICS: antipsychotic medications, weight monitoring, waist measurement, body weight tracking, medication side effects, BMI monitoring, blood labs, psychiatric medication management, mental health screening, inmate health monitoring, carbamazepine, valproic acid, lithium monitoring ATTACHMENTS: 1. Anxiolytic Informed Consent Form (M60-01-01H) URL: https://gps.press/sop-data/508.24-att-1/ 2. Abnormal Involuntary Movement Scale (AIMS) Assessment Form URL: https://gps.press/sop-data/508.24-att-2/ 3. Lockdown SLU_ACU_CSU Temperature Log URL: https://gps.press/sop-data/508.24-att-3/ 4. Medication Information for Hot Weather URL: https://gps.press/sop-data/508.24-att-4/ 5. Psychology_Psychiatry Transfer Evaluation URL: https://gps.press/sop-data/508.24-att-5/ 6. Initial Psychiatric/Psychological Evaluation (Form M60-01-06) URL: https://gps.press/sop-data/508.24-att-6/ 7. Antipsychotic Monitoring Log (M60-01-07) - Weight & Waist Circumference Record URL: https://gps.press/sop-data/508.24-att-7/ 8. Instructions for Completing Antipsychotic Weight & Waist Record (M60-01-08) URL: https://gps.press/sop-data/508.24-att-8/ ======================================================================== FULL TEXT: ======================================================================== 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.