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A review of required monitoring and management of physical health parameters in patients being treated with clozapine
Published online by Cambridge University Press: 18 June 2021
Abstract
To review available standards for physical health monitoring in people taking clozapine To audit current practice against standards To identify changes in practice and facilitate a re-audit to assess impact of any changes
Standard: CG178 Psychosis and Schizophrenia in Adults: Prevention and Management – NICE, February 2014
Target:100%
Exceptions: None
Sample: The original audit included all 58 patients from the Worcester clozapine clinic, as per October 2018. The re-audit reviewed a random sample of all patients attending the clozapine clinics in Worcester, Kidderminster and Redditch, as part of Worcestershire Health and Care NHS Trust, as per October 2019. A total of 66 patients were selected.
Data Source: Carenotes and ICE
Areas of good practice:
Monitoring of HbA1c and FBC remains good
There has been an improvement in monitoring alcohol use, substance misuse and side effects
Areas requiring improvement:
There continues to be limited recording of respiratory rate
There has been a decline in recording temperature, BMI and concomitant therapies
Potential reasoning for missing data includes:
Staff not knowing the monitoring requirements, which is more likely to be an issue when staff members running the clinics change frequently
Monitoring being completed but not documented
Patients’ refusal of monitoring
Data being recorded in alternative locations including general practice, without communication between services
Patients moving between teams or having inpatient stays may disrupt monitoring regime
LIMITATIONS
This audit assumes all patients involved to be on a stable dose of clozapine with routine monitoring
Some patients may have been transferred between teams or inpatients during the period of data collection
There is no scope to record when patients refuse monitoring
We may not have access to all notes such as those from general practice for data collection
RECOMMENDATIONS
Induction programme for junior doctors to include education on clozapine monitoring
Training for staff involved in clozapine clinics to ensure better understanding of monitoring requirements
Procurement of ECG machines for each site and relevant training for nursing and medical staff
Collaboration with GPs for shared data
Re-audit in 1 year
- Type
- Audit
- Information
- BJPsych Open , Volume 7 , Supplement S1: Abstracts of the RCPsych Virtual International Congress 2021, 21–24 June , June 2021 , pp. S111
- Creative Commons
- 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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