Physical Health Monitoring in Patients Established on Clozapine

AIMS: We set out to compare the physical health monitoring of patients established on Clozapine within our local mental health team (LMHT) to national and trust guidance. We also compared data collected in this audit with results from a similar audit conducted in 2018 to identify if improvements had been made to services. We then sought to present the findings to our LMHT to shape the formation of a newly set up pharmacy technician led Clozapine clinic. METHODS: National Institute for Health and Clinical Excellence (NICE) and Nottinghamshire Healthcare Trust (NHT) guidelines were reviewed to set criteria for the audit. Where NICE and NHT guidance stipulated similar recommendations, NICE guidance was used to set criteria. Criteria was found to be met if it had been collected within the last 12 months. Data were collected by a single clinician over the period of one month on review of electronic medical records. RESULTS: 30 patients were identified as established on Clozapine within our LMHT. 27 (90%) patients had a licensed diagnosis for Clozapine prescription. Smoking status was recorded in 26 (83.3%) patients and caffeine intake in 21 (70%) patients. Full blood count, liver function tests, urea and electrolytes all met the criteria at the 100% target however one patient was found to have Hba1c and lipid measurement outstanding. Weight was documented for 29 patients (96.7%) however waist circumference was documented in five (16.6%). This was the lowest scoring criteria. Pulse and blood pressure was recorded in 27 (90%) patients. Electrocardiograms were less consistently recorded as completed, with 22 (73.3%) recorded. Physical health monitoring was recorded for 27 (90%) patients, whilst 10 (33.3%) had a GASS-clozapine form completed. Percentages for all criteria that were measured in 2018 were found to be higher in the 2022 cycle. CONCLUSION: Findings show that physical health monitoring for the patients prescribed Clozapine in our LMHT does not consistently meet guidance. Development of a ‘Clozapine clinic’ was already planned. Results from this audit were shared within the LMHT and recommendations were made as follows; i) a measuring tape to be placed in each room ii) data such as weight, blood pressure and heart rate to be entered in a way that it can be plotted over time iii)pharmacy technician to work with a healthcare assistant to ensure all criteria can be met in the designated yearly Clozapine clinic