Presentation on theme: "National Adult Clozapine Titration Chart"— Presentation transcript:
1National Adult Clozapine Titration Chart Presented by __________________Facility/Unit____________________Prepared by the Australian Commission on Safety and Quality in Health Care
2National Adult Clozapine Titration Chart BackgroundA 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.
5Non-standard charting of clozapine on the NIMC Client A
6Non-standard charting of clozapine on the NIMC Client B
7National Adult Clozapine Titration Chart A standard National Adult Clozapine Titration Chart is intended to:Improve patient safety by reducing risk of medication errorAssist prescribers, dispensers and administrators with charting clozapine titration on the NIMCStandardise recording of clozapine titration ordersIt incorporates decision support, guidance and checklistsThe 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
10Facility identification and CPN Ensure facility identification is complete including ward or unit detailsComplete yearClozapine Patient Number (CPN) must be recorded on the facility identification space
11Patient identification Affix the current patient identification label (with the consumer’s name printed underneath by the first prescriber).ORAs a minimum, print legibly the patient’s name, UR number, address, date of birth and gender written in legible print.
12Cross-referencing with the NIMC Note that the patient has a National Adult Clozapine Titration Chart in use by ticking Other in Additional Charts on the patient’s NIMCWrite Clozapine titration next to the box to alert clinicians that the patient has an additional chart in use for clozapine titration
13Additional patient identification 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.
14Adverse drug reactions (ADRs) 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.
15Clozapine monitoringA 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.
16Clozapine registration reminder Contact the Clozapine Registration Centre for approvalObtain the Clozapine Patient Number and record it in the Facility Identification box
17Prescribing Prescriber signature is a legal requirement Prescriber identification (including contact details) is a safety requirement
19Blood test reminderA 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.
20Recommencing dosing after an interruption to therapy 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.
21Reasons for not administering doses When it is not possible to administer the prescribed clozapine, a reason for not administering code must be recorded and circled.
22Clozapine blood results monitoring system The chart provides an alert system which gives guidance on whether therapy should be continued or ceased according to the patient’s blood results.
23Clozapine pre-commencement guide All patients, prescribing doctors, dispensing pharmacists, clozapine coordinators and centres using clozapine must be registered with the Clozapine Patient Monitoring Service (CPMS).
24Blood test monitoring after an interruption to therapy 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.
25Nursing observationsPatients must be kept under close supervision and their vital signs monitored for six hours following the first dose of clozapine.
26Management of side effects A list of some side effects, as well as the time course and action, has been included on page 4. .