Low compliance with monitoring of waist measurement and lipid levels and inaccurate

information held on CPMS. The Trust management clozapine plan and policy of clozapine have been altered as a result of the audit. Clozapine check details treatment is associated with a potentially fatal agranulocytosis and thus registration with a clozapine monitoring service, e.g. Clozaril Patient Monitoring Service (CPMS), is required 1. NICE recommends annual monitoring of weight, waist measurement, blood pressure, blood glucose, and lipid levels and also gives guidance on clozapine augmentation 2. Inpatients on clozapine subject to Section 58 of the Mental Health Act must have a T2/T3 form specifying clozapine use and a maximum antipsychotic dose. The audit see more aims to evaluate compliance with clozapine therapy associated requirements. The population

consisted of all patients registered with active clozapine treatment on CPMS (141). Alternative patients registered on CPMS were selected for the audit. A criteria based data collection tool was developed with web-based software and used for collecting and analysing data. Medical notes, medicines administration record charts and T2/T3 forms of selected patients were examined on a retrospective basis from both inpatient and outpatient units. The audit was undertaken in November 2012-February 2013. Ethics approval was not required. A sample size of seventy-six patients, giving a confidence Glycogen branching enzyme level of 80%, was audited. Compliance with NICE recommended annual monitoring for seventy-one patients (five patients started the therapy less than 12months ago) is shown in the table 1. Accuracy of the data held on CPMS is summarised in the table 2. Table 1: Annual physical monitoring compliance with NICE Parameter Compliance Weight 65/71 (92%) Blood pressure 64/71 (90%) Waist measurement 6/71 (8%) Blood glucose 50/71 (70%) Lipid levels 29/71 (41%) Table 2: Accuracy of data held on CPMS Parameter Correct data Medical officer 55/76 (72%) Case holder

12/76 (16%) Team base 55/76 (72%) An additional antipsychotic drug for clozapine treatment augmentation was prescribed in thirteen patients and after the six week recommended trial. However, clozapine therapeutic levels were measured for only ten patients. Full compliance (100%) was observed for specifying treatment with clozapine and maximum antipsychotic dose on the T2/T3 forms. The audit also revealed that four patients were using clozapine for unlicensed indications without the required Drug and Therapeutic committee (DTC) approval. Poor compliance of physical monitoring with regards to waist measurement and lipid levels was observed. Recommendations to modify a currently used physical monitoring form for clozapine by including NICE monitoring advice was made and implemented.