Patient information standards (Clozapine)

All new patients for whom clozapine treatment is being considered will be given appropriate information to allow them to make an informed choice. Where patients lack capacity or are to receive compulsory treatment via a T2 or T3, information will be provided commensurate to their needs and capability.

At regular intervals (minimum annually) throughout clozapine treatment patients information needs will be assessed and appropriate information provided.

The information needs of patients will vary over time and often need to be tailored to their capacity and mental state at different stages of their illness.

The principle of the Montgomery ruling, is that patients are provided with information regarding material risks of treatment sufficient to allow a ‘reasonable’ person to make an informed choice.

Alternative treatments should also be discussed but that may be problematic with regards to treatment resistant schizophrenia.

In the context of clozapine such information will cover:

• What it is
• What it is for
• How long treatment is likely to last
• The need and rationale for regular blood tests (explaining red, amber, green results) and physical health checks (with an explanation of the function of CMHT clozapine clinics)
• How to take it including what to do about missed doses
• How prescriptions will be provided
• Very common and common side effects and what to do about them with a particular focus on constipation, sedation, hypersalivation, weight gain and urinary incontinence
• Where appropriate the likelihood of developing some of the more serious risks like cardiac problems, diabetes and seizures should be discussed in the context of enhanced monitoring
• Lifestyle advice
• Significant interactions especially alcohol and smoking
• Family planning and pregnancy where appropriate
• Compliance advice

Choice and Medication website

This includes a variety of patient information leaflets (in a variety of formats and languages), handy fact sheets and handy charts. These will be used to provide detailed information and reinforce verbal counselling to all prospective clozapine patients and on specific issues for existing patients.

NHS GG&C single topic clozapine information cards

This is a set of 6 cards developed by NHS GG&C Mental Health Pharmacy and CPNs from Riverside & the Stewart Centre CMHTs. The following topics are covered:

• Do you know why you need regular blood tests
• Do you know why you should try and take your clozapine regularly
• Do you know clozapine can cause constipation
• Do you know clozapine can cause weight gain
• Do you know smoking can affect the amount of clozapine in your blood
• Do you know clozapine can make you have too much saliva or make you dribble

Information produced by clozapine manufacturers

The 3 UK manufacturers provide a variety of patient information resources on clozapine tailored to their product. These can be used to compliment the resources above if necessary. Contact Leverndale Pharmacy for advice.

For prospective clozapine patients it is the duty of the ward MDT to ensure each patient’s information needs are assessed and met.

Ideally all prospective clozapine patients will have the opportunity to discuss clozapine treatment with a clinical pharmacist prior to treatment starting.

If this is not possible appropriate members of the MDT will provide the information as outlined in the information resources section above.

Consideration with regards to the level of initial information provided may depend on the patient’s mental state at the time.

Appropriate members of the MDT whether that be in hospital wards or community mental health teams will regularly assess and meet the information needs of clozapine patients under their care.

On an annual repeating basis pharmacy will provide clozapine out patients with the single topic clozapine cards. This will be one card per month for 6 months with each prescription issued.