Enhancement of Quality Care to Patient with Clozapine Treatment

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Authors (including presenting author) :
LEE CK(1), TANG CK(1), WONG CMA(1), HO YL(1),NG SC(1), MA PL(1)
Affiliation :
(1) Department of Psychiatry, Kowloon Hospital
Introduction :
Clozapine is an atypical antipsychotic agent which has been shown to be effective for treatment of resistive Schizophrenia.(Ma, 1993) However, Clozapine may lead to fatal agranulocytosis and it must be used under stringent blood monitoring(Working Group on New Psychiatric Drugs, COC (psy), 2016). For patient receiving Clozapine, prompt communication and close collaboration between treatment teams are important to ensure safety of patients and reduce the risk of potential fatal side effects. Reference 1. Incidence and risk factors in United States Jose Ma et al (1993) The New England Journal of Medicine 2. Reference R2: Clinical Guidelines on Prescribing and monitoring of Clozapine Therapy, by Working Group on New Psychiatric Drugs, COC (Psy) HAHO 2016
Objectives :
1) To prompt and increase awareness of Health Care Professionals (CMS users including HA doctors and private practitioners who join the eHRSS(醫健通) on patient with Clozapine treatment by Clozapine alert in CMS, treatment teams communication and standardized protocol on defaulter tracing. 2) To coordinate and collaborate the efforts of In-patient, Out-patient and Community Psychiatric Service to protect the patients from the risk of potential fatal side effect of Clozapine. 3) To empower and involve patients and their caregivers in treatment concordance
Methodology :
1) Develop Clozapine patient register. 2) Ensure Clozapine alert entry in CMS. 3) Develop Psychoeducation package: Clozapine pamphlet & alert card to facilitate patient and their caregiver’s understanding. 4) Develop Clozapine Psychoeducation program in KHPSYSOPC, KH Psychiatric In-patient and Community Psychiatric Service. 5) Enhance collaboration of KHPSYSOPC & Community Psychiatric Service on tracing of clozapine defaulters. 6) Enhance Communication with General Medical Teams (both HA and General Practitioners) 7) Empower patient in enrolling of eHRSS醫健通 and communication with Private Practitioners
Result & Outcome :
1) The Clozapine patient register was developed in 4/2018 and maintained bi-annually. 2) Compliance Audit on Structured Clozapine Alert in CMS was completed in 12/2018. All cases under Clozapine patient register (241) checked with 100% compliance rate. 3) Psychoeducation package: Clozapine pamphlet and alert card were developed in 4/2018. 4) Psychoeducation programs were fully implemented in Department of Psychiatry KH in 2/2019: In-patient: individual session by Primary Nurse; KHPSYSOPC: 46 small classes in 10/2018 and Community Psychiatric Service: individual session in Home base with 100% covered to all clients with Clozapine treatment. 5) Out-Patient Satisfaction survey on Clozapine Psychoeducation package was completed in 10/2018. 153 questionnaires sent with 71% returned rate. 90% participants agreed and strongly agreed that the information provided in package strengthen their understanding the safety use of Clozapine treatment. 6) A standardized defaulter tracing protocol was launched in 6/2018

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