Prescribing clozapine in the UK: Quality improvement issues identified by clinical audit. (September 2022)

• Record Type: Journal Article
• Authors: Barnes, Thomas RE; MacCabe, James H; Kane, John M; Delgado, Oriana; Khan, Mareeha; Paton, Carol
• Is Part Of: Journal of psychopharmacology. Volume 36:Number 9(2022)
• Page Start: 1036
• Page End: 1040
• Publication Date: 2022-09
• Subjects: Clozapine -- clinical audit -- quality improvement -- schizophrenia; Psychopharmacology -- Periodicals; 615.78
• DOI: 10.1177/02698811221104060
• Languages: English
• ISSNs: 0269-8811

Abstract

Introduction: The Prescribing Observatory for Mental Health initiated a quality improvement (QI) programme on clozapine use in UK mental health services. Methods: Clinical audits conducted in 2019 and 2021. Results: Sixty-three participating NHS Trusts/healthcare organisations in 2019, and 61 in 2021, submitted treatment data for 6948 and 8155 patients, respectively. In both audits, high-dose and/or combined antipsychotic medications had been prescribed immediately before initiating clozapine in over a quarter of patients recently started on clozapine. In patients who were tobacco smokers and recently discharged from a smoke-free ward, the impact of the potential change in smoking status had been considered in the care plans of just under one-third in 2019 and just over a half in 2021. For community patients, their Summary Care Records (SCRs) included their clozapine prescriptions in 58% of cases in 2019 and 72% in 2021. Conclusions: Three QI issues were identified. (1) Antipsychotic regimens with limited evidence for efficacy in treatment-resistant schizophrenia were prescribed for over a quarter of cases before starting clozapine. Use of such strategies may delay clozapine treatment, potentially reducing the likelihood of a therapeutic response. (2) While anticipation of the consequences of a change in smoking status on plasma clozapine concentration following discharge from hospital showed improvement over time, even in 2021 it was not evident for nearly a half of relevant cases. (3) While inclusion of clozapine in the SCR also improved over time, even in 2021 it was missing for more than a quarter of community patients.