Download clozapine community shared care pathway 20140228 (3)

CLOZAPINE PATHWAYS ACROSS SA
Community Mental Health Service
As per TGA endorsed Clozapine management protocols the consumer is to be seen every 7 or 28 days (depending
on whether they are on weekly or monthly monitoring) for clinical assessment of signs and symptoms of infection.
Consumer attends community
pathology collection centre for blood
test
Blood results returned to CMHS with
copy to nominated GP
Within 48hrs of blood test
Scheduled appointment at CMHS for review of consumer’s MSE, BP, weight, BMI,
pulse, temp, plus education & assessment of general tolerance & side effects of
Clozapine. - In addition to any other difficulties or concerns.
A medical officer is to review the
blood test & complete a Form 5
where required.
Authority prescription is to be written by an authorised clozapine prescriber & annotated with
streamlined code, exact quantity of tablets, hospital provide number & blood results (100mg
and 25mg tablets need to be written on separate prescriptions, as per PBS requirements)
Any dose changes MUST be authorised by a Consultant Psychiatrist
The Form 5 (if required) & prescription are forwarded to the registered
pharmacy by the CC via fax, post or consumer
Registered pharmacy dispenses clozapine
according to protocol
Blood results & clozapine dosage are entered into CPMS data base by the CC in metro areas
&/or by the registered pharmacist in rural areas.
All results (including BP, weight, BMI, pulse, temperature, and metabolic monitoring)
are entered onto the standard monitoring chart
BMI, Body Mass Index; BP, Blood Pressure; CC, Clozapine Coordinator; CMHS, Community Mental Health Service;
CPMS, Clozapine Patient Monitoring System; Form 5, the designated clozapine program blood count form; MSE,
Mental State Examination
Clozapine Shared Care Pathway 28 February 2014
Clozapine Shared Care Pathway 28 February 2014
Amber Result Pathway for Consumers Managed Under Shared Care Arrangements
Consumer attends community
pathology collection centre for blood
test
Blood results returned to GP with
copy to the CMHS CC
Amber result noted
Treating psychiatrist
notified by CC
CC notifies GP of Amber
result & discusses result
Consumer notified of
Amber result
GP & psychiatrist discuss
management
Within 48hrs of blood test
Scheduled appointment at GP for review of consumer’s MSE, BP, weight, BMI, pulse, temp, plus
education & assessment of general tolerance & side effects of Clozapine. - In addition to any other
difficulties or concerns.
GP to review the blood test &
complete a Form 5 if required
Authority prescription is to be written by an authorised clozapine prescriber & annotated with streamlined code,
exact quantity of tablets, hospital provide number & blood results (100mg and 25mg tablets need to be written on
separate prescriptions, as per PBS requirements)
Consumer takes prescription & Form 5 (if required) to the registered pharmacy
Registered pharmacy dispenses clozapine
according to protocol
Blood results & clozapine dosage are entered into CPMS data base by the CC in
metro areas &/or registered pharmacist in rural areas.
CC maintains up to date database on all consumers (including tracking of
blood testing, metabolic monitoring & cardiac monitoring as per TGA endorsed
protocol requirements)
CC & GP notified by CPMS fax
Increased monitoring as per TGA endorsed protocol
coordinated by CC in collaboration with GP & psychiatrist
When blood results in green continue as per protocol/plan
BMI, Body Mass Index; BP, Blood Pressure; CMHS, Community Mental Health Service; CC, Clozapine Coordinator;
CPMS, Clozapine Patient Monitoring System; Form 5, the designated clozapine program blood count form; MSE,
Mental State Examination
Clozapine Shared Care Pathway 28 February 2014
Red Result Pathway for Consumers Managed Under Shared Care Arrangements
Consumer attends community
pathology collection centre for blood
test
Blood results returned to GP with
copy to the CMHS CC
Red result noted
Treating psychiatrist
notified by CC
CC notifies GP of Red
result & discusses result
Consumer notified of Red
result by CC, requested to
have repeat blood test in
afternoon & told not to
take clozapine
Metro GP to hand management to CMHS clinic &
treating psychiatrist or rural GP to manage in
conjunction with treating psychiatrist
CC enters Red blood result
into CPMS database
CC & GP notified by
CPMS fax
Within 24 hours
Consumer to have repeat blood test
Consumer advised results of second test & appointments
Urgent appointments arranged at CMHS with psychiatrist & CC. In
rural/remote areas urgent GP & telemed psychiatrist review
Metro CC/ rural GP reviews consumer’s MSE, BP, weight, BMI,
pulse, temp, plus education & assessment of general tolerance &
side effects profile in addition to any other difficulties or concerns
Psychiatrist Review (of consumer, observations, & mental state)
Consumer advised management returning to CMHS (in conjunction with GP Rural/Remote) as
increased monitoring required. Consideration of alternative medication
NO CLOZAPINE PRESCRIPTION GIVEN
Increased monitoring as per TGA endorsed protocol.
Coordinated by CC in collaboration with Psychiatrist & GP
BMI, Body Mass Index; BP, Blood Pressure; CC, Clozapine Coordinator; CMHS, Community Mental Health Service;
CPMS, Clozapine Patient Monitoring System; MSE, Mental State Examination
Clozapine Shared Care Pathway 28 February 2014