Cargando…

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

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 loc...

Descripción completa

Detalles Bibliográficos
Autores principales: Evbuomwam, Ehimwenma, Kinnair, Dan, Mirza, Mohammad, Coleman, Julian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8770078/
http://dx.doi.org/10.1192/bjo.2021.248
_version_ 1784635287113039872
author Evbuomwam, Ehimwenma
Kinnair, Dan
Mirza, Mohammad
Coleman, Julian
author_facet Evbuomwam, Ehimwenma
Kinnair, Dan
Mirza, Mohammad
Coleman, Julian
author_sort Evbuomwam, Ehimwenma
collection PubMed
description 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. 1. What date was this started? 2. What date was either PRN or regular laxatives started? 3. Was a bowel chart recorded? 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.
format Online
Article
Text
id pubmed-8770078
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Cambridge University Press
record_format MEDLINE/PubMed
spelling pubmed-87700782022-01-31 Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT) Evbuomwam, Ehimwenma Kinnair, Dan Mirza, Mohammad Coleman, Julian BJPsych Open Audit 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. 1. What date was this started? 2. What date was either PRN or regular laxatives started? 3. Was a bowel chart recorded? 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. Cambridge University Press 2021-06-18 /pmc/articles/PMC8770078/ http://dx.doi.org/10.1192/bjo.2021.248 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/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.
spellingShingle Audit
Evbuomwam, Ehimwenma
Kinnair, Dan
Mirza, Mohammad
Coleman, Julian
Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
title Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
title_full Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
title_fullStr Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
title_full_unstemmed Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
title_short Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
title_sort constipation and clozapine: a qi project in leicestershire partnership nhs trust, (lpt)
topic Audit
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8770078/
http://dx.doi.org/10.1192/bjo.2021.248
work_keys_str_mv AT evbuomwamehimwenma constipationandclozapineaqiprojectinleicestershirepartnershipnhstrustlpt
AT kinnairdan constipationandclozapineaqiprojectinleicestershirepartnershipnhstrustlpt
AT mirzamohammad constipationandclozapineaqiprojectinleicestershirepartnershipnhstrustlpt
AT colemanjulian constipationandclozapineaqiprojectinleicestershirepartnershipnhstrustlpt