P0251 - Does prescribing practice of clozapine affect length of stay in psychiatric in-patient units?

Abstract

Background and Aims:

Clozapine remains the gold standard for the management of treatment-resistant schizophrenia. Due to the need for close medical supervision at initiation it is usually started in hospital although this is no longer mandatory. It is estimated that speed of up-titration will affect length of stay.

Methods:

Retrospective study of prescription charts of 14 patients representing the most recent who have been prescribed clozapine as in-patients. Data would be compared against the titration doses recommended by the British National Formulary and by the manufacturers (Novartis).

Results:

5/14 patients were admitted solely for clozapine initiation. 1/14 did not tolerate it after 5 days. 2/14 patients were re-started clozapine following a period of discontinuation and their discharge dose was achieved faster than initial titration as recommended. 9/14 patients’ titration was slower than recommended by the guidelines with a minimum difference of 113 days if using the slower recommended titration or a maximum of 208 days if using the faster one. None of the patients’ titration appeared to be slowed down due to the presence of emerging side-effects.

Conclusions:

Prescribing practice appears to lengthen hospital admissions due to delays in changing doses. This was less relevant for patients admitted exclusively for clozapine initiation. The development of a policy for community initiation and the development of a pre-printed up-titration chart for clozapine are potential solutions to minimise bed occupancy therefore improving both patients’ experiences and bed management.