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NIMC (clozapine titration)
Presented by __________________
Facility/Unit____________________
Prepared by the Australian Commission on Safety and Quality in Health Care
NIMC (clozapine titration)
Background
– A 2011 national survey of National Inpatient Medication
Chart (NIMC) users in psychiatric acute services found that
charting clozapine titration was problematic.
– Clozapine titration prescribing was non-standardised and
found variously in the Once Only / Variable Dose section
and the Regular sections of the NIMC.
– Non-standard practices created increased opportunity
for harm to our consumers.
Non-standard charting of clozapine on the NIMC
Non-standard charting of clozapine on the NIMC
Non-standard charting of clozapine on the NIMC
Client A
Non-standard charting of clozapine on the NIMC
Client B
NIMC (clozapine titration)
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A standard national adult clozapine titration chart is intended
to:
• improve patient safety by reducing risk of medication
error
• assist prescribers, dispensers and administrators with
charting clozapine titration on the NIMC
• standardise recording of clozapine titration orders
It incorporates decision support, guidance and checklists
The NIMC (clozapine titration) is based on the Queensland
Health Adult Clozapine Titration Chart which was developed
jointly by Medication Services Queensland and Queensland
Psychotropic Medication Advisory Group
National Adult Clozapine Titration Chart
Facility identification and CPN
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Ensure facility identification is complete including ward or unit
details
Complete year
Clozapine Patient Number (CPN) must be recorded on the
facility identification space
Patient identification
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Affix the current patient identification label (with the consumer’s
name printed underneath by the first prescriber) to pages 2 and 4.
OR
As a minimum, print legibly the patient’s first and family names,
UR number, address, date of birth and gender written in legible
print.
Cross-referencing with the NIMC
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Note that the patient has a NIMC (clozapine titration) in use by
ticking Other in Additional Charts on the patient’s NIMC
Write Clozapine titration next to the box to alert clinicians that the
patient has an additional chart in use for clozapine titration
Additional patient identification
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A space for hand writing patient identification is provided on
page 3.
It is designed for health services that use medication chart
scanners.
Health services that do not use scanners may use the
identification space as an additional safety device.
Adverse drug reactions (ADRs)
• All patients should have details of previous adverse drug
reactions (ADRs) recorded on their NIMC (acute) or NIMC (longstay)
• Attach an ADR sticker to the NIMC (clozapine titration) section
provided if the patient has an ADR recorded
• Refer to the NIMC for details of previous ADRs and allergies.
Clozapine monitoring
• A check list of investigations
required for clozapine
monitoring is provided on
page 1.
• These are suggested
guidelines only and the
treating psychiatrist may
request further tests
depending on clinical results
or local policy.
Clozapine registration reminder
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Contact the Clozapine Monitoring Centre for approval
Obtain the Clozapine Patient Number and record it in the
Facility Identification box
Prescribing
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Prescriber signature is a legal requirement
Prescriber identification (including contact details) is a safety
requirement
Administration record
Blood test reminder
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A red coloured square is printed on days 7, 14, 21 and 28 as a
reminder that patients require blood or metabolic monitoring on a
weekly basis as indicated on the Clozapine Commencement
Monitoring: Baseline Measurements section of the chart.
Additional tests may be indicated by the doctor drawing a
darkened line around the day box on the required testing day.
Recommencing dosing after an interruption to therapy
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If a dose is missed for greater than 48 hours, a psychiatric
review must be performed prior to recommencing clozapine
treatment.
Additional guidance is provided.
Reasons for not administering doses
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When it is not possible to administer the prescribed clozapine, a
reason for not administering code must be recorded and
circled.
Clozapine blood results monitoring system
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The chart provides an alert system which gives guidance on
whether therapy should be continued or ceased according to the
patient’s blood results.
Clozapine pre-commencement guide
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All patients, prescribing doctors, dispensing pharmacists,
clozapine coordinators and centres using clozapine must be
registered with the Clozapine Patient Monitoring Service
(CPMS).
Blood test monitoring after an interruption to therapy
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All patients recommencing clozapine following an interruption in
treatment must have a pre-treatment blood test. This includes
patients with therapy interruptions of less than a week.
Nursing observations
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Patients must be kept under close supervision and their vital
signs monitored for six hours following the first dose of
clozapine.
Management of side effects
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A list of some side effects, as well as the time course and action,
has been included on page 4. .
Questions