|Title:||Implementation of the WA Clozapine Initiation and Titration Chart in Mental Health Units (Revised January 2016)|
|Document ID:||Operational Directive OD 0596/15|
|Date of issue:||Wednesday, 22 April 2015|
|Description:||This operational directive specifies the use of the WA Clozapine Initiation and Titration Chart for the prescribing, administration and monitoring of clozapine in all WA Public hospitals with a mental health facility.|
|Legal requirements:||The Poisons Act 1964
Medicines and Poisons Act 2014
|Applicable to:||Health services with mental health units|
|Framework:||Mental Health Policy Framework|
|Period of effect:||from 15 May 2015 to 15 May 2018|
|Review date:||30 November 2015|
|Authorised by:||Dr D J Russell-Weisz, Director General, Department of Health WA, 07-Jan-2016|
|Print version:||View print version|
Implementation of the WA Clozapine Initiation and Titration Chart in Mental Health Units (Revised January 2016)
Clozapine is well recognised as a high risk medication.
Clozapine was initially released in the early 1970s and withdrawn from the market in 1975 due to incidents of neutropenia, myocarditis and sudden death. It was re-introduced for use in Australia with stringent monitoring requirements co-ordinated by the National Clozapine Monitoring System (currently through Clopine Connect®) including white cell count and neutrophil levels as well as vital observation monitoring at baseline and during the first week of therapy.
Blood pressure, pulse, temperature and respirations must be monitored hourly for the first six hours of treatment then six hourly for the first 24 hours. A minimum of twice daily monitoring of these parameters is required for days 2-7 of clozapine initiation. Frequency of observations required for clozapine commencement differs from the standard mental health routine observations that would be in place for a patient commencing any other drug.
The Clozapine Chart facilitates clinical handover and prescription for the safe management of patient initiated or re-titrated on clozapine. Decision support is also provided on the chart.
The chart was developed by the Change Management and Quality Improvement Unit in consultation with the Chief Psychiatrist’s Office, with input from psychiatrists and pharmacists from FHHS and Graylands Hospital.
The chart has been endorsed by the WA Therapeutic Advisory Group (WATAG) and two of its subcommittees: the WA Medication Safety Group (WAMSG) and the WA Psychotropic Drug Committee, the Office of the Chief Psychiatrist and the State Executive Directors of Nursing and Midwifery.
This operational directive specifies the use of the WA Clozapine Initiation and Titration Chart for the prescribing, administration and monitoring of clozapine in all WA Public hospitals with a mental health facility.
The Poisons Act 1964 restricts the prescription of clozapine to psychiatrists. Hence the WA Clozapine Initiation and Titration Chart is mandated for restricted use in mental health units as this is the only setting where clozapine will be commenced and monitored under the direct supervision of a psychiatrist.
Pre-screening prior to commencement of clozapine must be documented on the front of the WA Clozapine Initiation and Titration Chart for clozapine naïve patients.
Clozapine therapy may not be initiated until the pre-screening has been completed, the patient has completed a Clozapine Referral Form, the patient has been provided a Clozapine Notification Form and Consumer Medication Information pertaining to Clozapine, consent is obtained, the patient is registered with the Clozapine Monitoring System and has been provided with a registration number and baseline tests have been done a maximum of 10 days prior to commencing therapy.
While use of the chart for prescribing and administering clozapine is mandated, dosing guidelines contained within the chart are recommendations only. These do not cover all clinical scenarios and do not replace the need for clinical judgement.
The WA Clozapine Initiation and Titration Chart must be implemented in all WA mental health facilities as early as practical, no later than 15 May, 2015. It is the responsibility of the hospital to ensure all medical, nursing and pharmacy staff involved in clozapine management are educated appropriately on the use of the chart.
A number of resources (Chart Guidance Document and PowerPoint for educating staff) are available to assist with implementation of the WA Clozapine Initiation and Titration Chart and these are available on the Office of Safety and Quality in Healthcare website http://www.safetyandquality.health.wa.gov.au
Use of ancillary charts
It is recognised that missed doses may be an unintended consequence of the use of ancillary/specialised medication charts. For this reason it is imperative that the current national NIMC for the patient is appropriately annotated on the front of the chart to indicate the use of the WA Clozapine Initiation and Titration Chart. This specialised chart must be kept with other medication charts (i.e., National Inpatient Medication Chart) for the patient.
Artwork for the chart is available through the Quality Improvement and Change Management Unit and from the printing company tendered to print medication charts for WA Health through the Health Corporate Network (currently, Print Media Group, ph. (08) 6272 4600). Chart version, identification and date codes are as follows:
0 global version, number controlled centrally (global version 3 will be in circulation until advised otherwise)
AAA hospital identification, up to 3 letters
# hospital version number, up to 3 digits
M month (as a number) version was generated by the hospital
Y year (as a number) version was generated by the hospital
Recommending a change to the WA Clozapine Initiation and Titration Chart
Recommendations for change of the WA Clozapine Initiation and Titration Chart can be made via email to email@example.com
Recommendations for change must be evidence based, with the primary objective of improving patient safety.
Health Services should monitor compliance against the features of the chart in terms of completion of appropriate sections. Dosing and monitoring recommendations are to be applied at the discretion of the medical staff and do not replace clinical judgement.
Dr D J Russell-Weisz
This circular last updated: Wednesday, 24 February 2016 at 11:45am