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Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)

Published online by Cambridge University Press:  18 June 2021

Ehimwenma Evbuomwam ,
Dan Kinnair ,
Mohammad Mirza  and
Julian Coleman
Ehimwenma Evbuomwam*
Affiliation:
Leicester Partnership Trust
Dan Kinnair
Affiliation:
Leicestershire Partnership Trust, University of Leicester
Mohammad Mirza
Affiliation:
Leicestershire Partnership Trust, University of Leicester
Julian Coleman
Affiliation:
Leicester Partnership Trust
*
*corresponding author.
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Abstract

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Aims

Constipation in patients on Clozapine is the biggest cause of mortality. We have no set protocol in LPT for how to manage and monitor Constipation in Clozapine initiation in the inpatient setting. Internationally protocols, (such as the Porirua protocol) exist but have not been widely used locally.

We wanted to assess local compliance with monitoring constipation in patients admitted to hospital and started on Clozapine. We also wanted to assess whether patients are prescribed PRN or regular laxatives, before considering implementing a local protocol.

Method

In LPT we use the ZTAS system for prescribing Clozapine. They provided us with a list of patient IDs who had recently started on Clozapine.

We captured data on patients started on Clozapine.

  1. 1. What date was this started?

  2. 2. What date was either PRN or regular laxatives started?

  3. 3. Was a bowel chart recorded?

  4. 4. Any evidence of constipation or significant bowel issues relating to Clozapine?

Result

We initially analysed 30 patients, (20 of whom were initiated on Clozapine as inpatients, and 10 as outpatients). A bowel chart was started in only 1 inpatient. Laxatives were started in 50% (15, only 3 of whom were outpatients). 14 were regular and 1 was a PRN prescription. 12 inpatients had constipation, and 1 outpatient suffered with constipation. 2 patients suffered with diarrhoea but there were no other significant issues with bowel problems.

Conclusion

From our initial data we can see that there are many inconsistencies in practice.

Existing patients on Clozapine attend a local clinic, (Clozapine clinic) where ongoing monitoring of constipation, (and other parameters, e.g. ECGs etc are completed).

We have written a new protocol which we will share, that the trust has implemented, that identifies when PRN and regular laxatives should be prescribed. We have also expanded the protocol to agree for initiation of Olanzapine bowel charts and PRN laxatives should be used.

Type
Audit
Information
BJPsych Open , Volume 7 , Supplement S1: Abstracts of the RCPsych Virtual International Congress 2021, 21–24 June , June 2021 , pp. S79
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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