This issue of Promising Practice highlights how the nurse practitioner and nurse care coordinators at Canadian Mental Health Association (CMHA) Thunder Bay Branch have been using this tool in their practice during intake/initial assessment visits, and six month follow-ups.
What you need to know
The Early Psychosis Intervention Ontario Network (EPION) developed the Metabolic Monitoring Interactive Tool to provide a structured way to screen and begin metabolic interventions for people with mental illness.
CMHA Thunder Bay highlights that the tool has a very simple structure to capture all the domains and areas in metabolic monitoring. It is easy to use, brief, and can be tailored to suit the program and client. This tool allows clients to:
- track their own metabolic risk factors
- set related healthy lifestyle goals, healthy target zones and calendar reminder to continue monitoring and following up on their goals.
Read this Promising Practice below or download the PDF.
The EPION Metabolic Monitoring Working Group developed this interactive web tool to promote metabolic monitoring for people with mental illness.
This tool allows clients and clinicians to monitor clients’ measurements (waist, blood pressure, HDL cholesterol, triglycerides, blood sugar, and body mass index), medications and current side effects, lifestyle (smoking, alcohol use, exercise), sleep and nutrition.
The tool does not collect any personal health information. Once clients have entered all the necessary information, they can print a copy or save it to their computer.
Keri, Emily and Corrine, Nurse Care Coordinators at CMHA Thunder Bay shared their experiences and tips for using the tool with clients.
How many clients have used the tool and how often?
We started using the tool in summer 2019 with more at-risk clients, not all clients. A total of four clients have used it and an additional two other nurses have just started using the app. We usually follow up with our clients every six months along with blood work for metabolic monitoring. However, the frequency depends on the client. New clients would have weekly follow-ups, and at-risk clients are monthly.
How was the tool implemented in your program?
The app is very user-friendly. Our nurse practitioner told everyone about the tool, and everyone was on board to start using it. We have always done our own way of metabolic monitoring with our clients in different ways such as charting, but the tool gives a more accurate way to track it in an app. Three nurses and one nurse practitioner are using the tool with clients.
Prior to using this tool, what did you do with regards to metabolic monitoring?
We have always done blood work at the start of an appointment, then we would follow up after six months or sooner depending on the client. All metabolic measurements were done, such as vitals, weights and check-ins on their health goals. Prior to the app, all this was charted on pre-made notes and so monitoring was done in that way. Using the app has changed our practice. Our recovery workers, along with the nurses, can now better help clients work on their goals. The app is a great way of tracking clients’ goals and metabolic monitoring! We have not tried any other tools for metabolic monitoring, but having a concrete app has really made a difference!
How are you using the tool and explaining the process to clients?
We initially book an appointment with the nurse practitioner, then we put the app right up on the screen so clients can see all the measurements and results. We go through each step and explain every aspect of the metabolic monitoring with our clients, such as the results of each level of the blood work.
What are some challenges of using the tool?
Some clients do not want to know some of the required measurements in the app, like their weight. So they focus on other measurements and aspects of the app. Some clients are also regional, so it’s harder to do the metabolic monitoring with them, if they can sign in and see visuals for themselves and do it themselves. Another challenge was rolling out the app. The nurse practitioner must do the blood work and give the results, so waiting for them to do that first is a barrier, and then nurses can use the tool.
What are the benefits of using the tool?
Once clients see the results physically in an app, they are able to better recognize and visualize their target zones. Rather than us nurses just telling them that they are at risk, the app is a good reinforcement of the areas they need to improve on. The visual aspect of the app also helps clients see their progress. Some aspects of the app like the goal sheet and the what/where makes the app more personalized to the client and easier to track their measurements.
Have you seen any changes in clients since using the tool?
Yes, we saw changes in the first couple weeks that they started using the app. In this time period, the clients are motivated to track, achieve and follow up on their health goals. However, after this time period, the motivation phases out. Since it does take six months to see blood work changes, it makes it more challenging for clients to stay motivated in achieving their goals.
For the most part, nurses have always tried to help with metabolic work and keep clients motivated to continue with their healthy lifestyle journey. We had a client who was over 300 pounds and is now down to 250 pounds since starting to use the app. The client really enjoys the visual piece of the app and feels motivated to continue with his goals! No negative feedback from clients! The app is better at tracking goals, so they like it!
Are there any important things people should consider before using this tool?
Before using the tool, it is important that nurses talk with their clients about the app to explain the importance of the app and how it will benefit them in their healthy lifestyle journey. This should all be done before any blood work is done so that the client is fully aware of how to use this metabolic monitoring app.
Access more information about the tool.
Author: Maryan Warsame