Physical health monitoring in Clozapine patients

Presentation Winner of HEAT 2016 Event

Abstract

Introduction: The atypical antipsychotic Clozapine controls the cognitive, positive and negative symptoms of schizophrenia more effectively than alternative medications. However, use is limited due to potential severe adverse effects including agranulocytosis; patients thus need frequent review(1) but studies show monitoring to be poor(2).

Methods: A SHSC lead pharmacist identified 30 patients prescribed Clozapine. 10 audit standards were developed using Maudsley and NICE guidance(3,4), including annual weight, blood tests and blood pressure (BP) measurements. The electronic notes system, Insight, was used to review blood results and GP surgeries telephoned to determine if patients had attended for an annual physical health review.

Results and discussion: All patients had a monthly full blood count (FBC). 7% (n=2) had prolactin levels or an electrocardiogram within the previous year. The other audit criteria had compliance rates between 63% (n=19) for body mass index to 6.7% (n=26) for BP monitoring. Poor compliance could be due to patient factors such as limited insight, or physician factors including DNA frustation or poor Clozapine awareness.

Conclusion: There is definite scope to improve compliance therefore key recommendations were made including rescheduling DNAs, organising blood tests alongside monthly FBCs, design of a Clozapine monitoring checklist and re-audit in one year.