Q Exchange
Community initiation of clozapine within a mental health rehabilitation team
- Shortlisted idea
- 2023
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Treatment-resistant schizophrenia (TRS) is defined as a failure to respond to two trials of antipsychotic medication, of adequate dose and duration. The well-established gold standard pharmacological management for TRS is clozapine. In 2018, the national clinical audit of psychosis highlighted that clozapine was only prescribed for approximately 50% of patients with treatment-resistant schizophrenia.
Currently within the Trust there is no provision for the community initiation of clozapine.
There is very high bed occupancy across the Trust, which is a significant barrier to any attempts to expand the use of clozapine to those patients who do not require acute inpatient care. In addition, there likely to be many patients who are not agreeable to a trial of clozapine if there is a requirement to be admitted to hospital.
Developing a safe and effective pathway for the community initiation of clozapine would improve access to clozapine and directly reduce the delays patients currently experience.
What does your project aim to achieve?
The overall aim is to improve access to the clozapine, via the development of a clinical pathway for the community initiation of clozapine. The short term aim is to support a minimum of 5 patients to start clozapine in the community by the end of 2023.
How will the project be delivered?
The recent launch of the community rehabilitation services across DPT presents a good opportunity with regards to community clozapine initiation; the focus on patients with complex psychosis means the skills and experience within these teams lends itself well to supporting patients to access clozapine.
A clinical pathway has been developed within the community rehabilitation team in Exeter. The team will lead on the whole process of initiating clozapine for a patient in their home.
How is your project going to share learning?
The previously mentioned national audit of psychosis demonstrates a lack of provision for clozapine across the UK. Any learning from this project would hopefully support an improvement in this area across the country.
Locally as part of the South-West community rehabilitation forum, we are due to present to other teams across the region on this work.
How you can contribute
- Shared experience of engaging people with lived experience of schizophrenia in the development of treatment pathways.
- Shared experience of developing patient resources when developing new treatment pathways.
Plan timeline
| 1 Mar 2023 | Team engagement and training |
|---|---|
| 16 Mar 2023 | Pilot protocol to be completed |
| 1 May 2023 | Launch pilot for referrals |
| 1 Jul 2023 | Review process after first referral |
| 1 Dec 2023 | Review project aim and outcomes |
Comments
Helen Crimlisk 23 Mar 2023
An important area.
Clozapine is an excellent treatment which is offered too little because of the complexities around prescribing.
There should be ways of initiating it in the community. We have some experience of doing this with the help of our Decisions Unit and the Home Treatment Team, but are clear that provision is not sufficient. Very interested to hear how you get on. We have been considering training up New Roles professionals in this area such as PAs/ ACPs /Prescribing pharmacists. Have you considered this? Do need new policies to manage risk element of this?
Samantha Churchward 24 Mar 2023
Thanks Helen. Yes very happy to share how we get on and link in with you further. We are considering new roles as part of this and one of our prescribing pharmacists is leading on this. We are updating our clozapine protocol to include this and providing extra training on clozapine for the staff involved. We are using the model for improvement to help us introduce the changes slowly and learn and manage the risk as we go along.
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