Clozapine – physical health and side effects monitoring. Don’t just screen – intervene

A qualitative exploration of the barriers to and facilitators of clozapine monitoring in a secure psychiatric setting

“…Despite this, studies repeatedly report that adherence to the required monitoring, in both in-patient and community settings, is incomplete. [2][3][4][5][6]10,11 Although clozapine is widely used in forensic settings, there is very little published literature relating to its use here. This qualitative study has provided valuable insight into clozapine monitoring in a secure unit and has identified facilitators and barriers to effective monitoring.…”

“…Inconsistent documentation, limited knowledge about clozapine and a lack of communication between teams have previously been shown to limit improvements when abnormalities are detected. 4,6 Logistically, access to phlebotomy-trained staff was a key barrier to on-schedule monitoring, which has been highlighted in previous audits of clozapine monitoring. 2,3 From a patient perspective, monitoring was passive, and many had little insight into the monitoring requirements.…”

“…Any system of monitoring must be supported by electronic tools to keep track of monitoring. 6 An in-patient clozapine clinic is an effective system for clozapine monitoring that is widely supported by staff and patients. This provides FBC monitoring, along with monitoring of other physical health parameters and side-effects.…”

“…14 Clozapine monitoring must be supported by care pathways and effective interventions to ensure that, first, monitoring takes place and, second, that abnormal findings are actioned. 6 Pathways should be standardised so that they can be easily followed by busy staff working across wards. Any system of monitoring must be supported by electronic tools to keep track of monitoring.…”

“…[2][3][4][5] Even where abnormalities are identified, this often does not translate into results being communicated or acted upon. 2,5,6 A previous evaluation of shared-care clozapine monitoring found that implementing a different model of monitoring could feel process-driven and generate anxiety for staff, with a recommendation to identify facilitators and barriers to ensure that change is successful and sustained. 7 Therefore, in this study, we aimed to explore the beliefs and understanding of staff and patients at a secure mental health unit regarding clozapine monitoring, and to use this information to identify barriers to and facilitators of monitoring.…”