Increasing Monitoring and Management of Side Effects from Atypical Antipsychotic Medications in Children with Developmental Disabilities

Background: Behavior difficulties such as irritability, aggression, and repetitive and challenging behaviors are common in children with Autism Spectrum Disorder (ASD) and other developmental disabilities (DD). Atypical antipsychotic medications (AAPM) are currently first-line pharmacological agents for treatment of these behaviors. However, there are significant associated adverse effects of AAPM in children, including excessive weight gain, abnormal involuntary movements, and laboratory abnormalities. A recent chart review of children with ASD treated with AAPM revealed that 40% had overweight or obesity (OW/OB). Problem: Despite significant long-term health risks, the Division of Developmental and Behavioral Pediatrics (DBP) does not have consensus guidelines for clinicians to monitor and treat adverse side effects of AAPM. Little data is available regarding current DBP clinician practices and areas for improvement. Aim statement: By June 2018, 40% of children treated with AAPM will have a documented and executed plan for monitoring, treatment and follow-up. The long-term aim is to improve the safe use of AAPM and to improve patient health, including fewer comorbid medical conditions and decreased frequency of OW/OB. Methods: Clinicians from DBP were surveyed about current practices in prescribing and monitoring AAPM, perceived barriers to appropriate monitoring, and areas in need of intervention. A chart review was completed for baseline data about AAPM prescribing and monitoring practices within DBP. Barriers and potential interventions were identified, and will serve the basis for development of a key driver diagram to identify interventions that will have impact on the leverage points to achieve our aims. Results: Data from provider survey was entered into tally sheets and displayed as a Pareto diagram to focus on areas for impact. Clinical providers identified top barriers for ordering labs to be previous lab results, family non-compliance, patient behaviors and abnormal weight gain. Barriers to families completing laboratory testing were lack of time in the visit to discussing getting labs, lack of family buy-in and insurance issues. Of interest, baseline chart review revealed that 75-85% of providers ordered appropriate individual lab tests, and 73% of them were completed. However, a notable finding is that 10% of patients had the full recommended laboratory monitoring panel ordered. Intervention and expected outcomes: Using national guidelines,