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National Adult Clozapine Titration Chart Presented by __________________ Facility/Unit____________________ Prepared by the Australian Commission on Safety.

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Presentation on theme: "National Adult Clozapine Titration Chart Presented by __________________ Facility/Unit____________________ Prepared by the Australian Commission on Safety."— Presentation transcript:

1 National Adult Clozapine Titration Chart Presented by __________________ Facility/Unit____________________ Prepared by the Australian Commission on Safety and Quality in Health Care

2 National Adult Clozapine Titration Chart Background –A 2011 national survey of National Inpatient Medication Chart (NIMC) users in psychiatric acute services found that charting clozapine titration was problematic. –Clozapine titration prescribing was non-standardised and found variously in the Once Only / Variable Dose section and the Regular sections of the NIMC. –Non-standard practices created increased opportunity for harm to our consumers.

3 Non-standard charting of clozapine on the NIMC

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5 Non-standard charting of clozapine on the NIMC Client A

6 Non-standard charting of clozapine on the NIMC Client B

7 A standard National Adult Clozapine Titration Chart is intended to: Improve patient safety by reducing risk of medication error Assist prescribers, dispensers and administrators with charting clozapine titration on the NIMC Standardise recording of clozapine titration orders It incorporates decision support, guidance and checklists The National Adult Clozapine Titration Chart is based on the Queensland Health Adult Clozapine Titration Chart which was developed jointly by Medication Services Queensland and Queensland Psychotropic Medication Advisory Group National Adult Clozapine Titration Chart

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10 Ensure facility identification is complete including ward or unit details Complete year Clozapine Patient Number (CPN) must be recorded on the facility identification space Facility identification and CPN

11 Affix the current patient identification label (with the consumer’s name printed underneath by the first prescriber). OR As a minimum, print legibly the patient’s name, UR number, address, date of birth and gender written in legible print. Patient identification

12 Note that the patient has a National Adult Clozapine Titration Chart in use by ticking Other in Additional Charts on the patient’s NIMC Write Clozapine titration next to the box to alert clinicians that the patient has an additional chart in use for clozapine titration Cross-referencing with the NIMC

13 A space for hand writing patient identification is provided on page 3. It is designed for health services that use medication chart scanners. Health services that do not use scanners may use the identification space as an additional safety device. Additional patient identification

14 All patients should have details of previous adverse drug reactions (ADRs) recorded on their National Inpatient Medication Chart (NIMC) Attach an ADR sticker to the National Adult Clozapine Titration Chart section provided if the patient has an ADR recorded. Refer to the NIMC for details of previous ADRs and allergies. Adverse drug reactions (ADRs)

15 A check list of investigations required for clozapine monitoring is provided on page 1. These are suggested guidelines only and the treating psychiatrist may request further tests depending on clinical results or local policy. Clozapine monitoring

16 Contact the Clozapine Registration Centre for approval Obtain the Clozapine Patient Number and record it in the Facility Identification box Clozapine registration reminder

17 Prescriber signature is a legal requirement Prescriber identification (including contact details) is a safety requirement Prescribing

18 Administration record

19 A red coloured heart symbol is printed on days 7, 14, 21 and 28 as a reminder that patients require blood or metabolic monitoring on a weekly basis as indicated on the Clozapine Commencement Monitoring: Baseline Measurements section of the chart. Additional tests may be indicated by the doctor drawing a darkened line around the day box on the required testing day. Blood test reminder

20 If a dose is missed for greater than 48 hours, a psychiatric review must be performed prior to recommencing clozapine treatment. Additional guidance is provided. Recommencing dosing after an interruption to therapy

21 When it is not possible to administer the prescribed clozapine, a reason for not administering code must be recorded and circled. Reasons for not administering doses

22 The chart provides an alert system which gives guidance on whether therapy should be continued or ceased according to the patient’s blood results. Clozapine blood results monitoring system

23 All patients, prescribing doctors, dispensing pharmacists, clozapine coordinators and centres using clozapine must be registered with the Clozapine Patient Monitoring Service (CPMS). Clozapine pre-commencement guide

24 All patients recommencing clozapine following an interruption in treatment must have a pre-treatment blood test. This includes patients with therapy interruptions of less than a week. Blood test monitoring after an interruption to therapy

25 Patients must be kept under close supervision and their vital signs monitored for six hours following the first dose of clozapine. Nursing observations

26 A list of some side effects, as well as the time course and action, has been included on page 4.. Management of side effects

27 Questions


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