Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Hung SS, Tsang FH, Hui YTE, Chong CH
Affiliation :
Department of Pharmacy, United Christian Hospital
Introduction :
Clozapine is an effective agent in managing patients with schizophrenia resistant to other antipsychotic drugs. However, it is associated with risk of fatal agranulocytosis. The Clinical Guidelines on Prescribing and Monitoring of Clozapine Therapy by Hospital Authority Head Office (HAHO) mandates the establishment of “local monitoring system” to ensure implementation of “no blood, no drug” policy to all users of clozapine.
In United Christian Hospital, the conventional monitoring system involved extensive documentation and manual workload that was spread among psychiatrists, nurses, clerical staff and pharmacy staff. In 2020, a multidisciplinary collaboration between the Psychiatry department and Pharmacy established a new Pharmacist Clozapine Monitoring Service with the aim of streamlining workflow for clozapine monitoring and optimising the utilisation of resources.
Objectives :
To streamline workflow of clozapine monitoring across different healthcare professionals; to optimise utilisation of resources; to simplify patient journey.
Methodology :
Pharmacist took over from psychiatrists and nurses the regular duties of ordering blood, reviewing blood results, and corresponding CMS documentations. Psychiatrists and nurses only needed to manage blood monitoring on the date of consultation, and book appointments for blood monitoring in-between consultations.
Defaulted cases were also traced by pharmacists. With the aid of computerised documentation system, pharmacist could plan two weeks in advance of each blood monitoring appointments. Defaulted cases were automatically flagged and traced by pharmacist according to predefined protocol. Those who failed first tracing would be referred back to Psychiatry for further follow-up.
A time-motion study was performed before and 3 months after the implementation of the new workflow. Time differences in performing various motions were measured by direct observation or by self-reporting. Time differences in completing patient journey were also analysed.
Result & Outcome :
Average time pre-implementation for psychiatrists and nurses to review blood results, order blood form, document in CMS and prepare drug refill coupon was 2 minutes 45 seconds per case. This was reduced by 46% to 1 minutes 29 seconds under the new workflow, with one pharmacist performing all the tasks in one instance. Average time required for patients to refill clozapine was markedly reduced by 69% from 25 minutes to 8 minutes. On average, pharmacist managed 80-100 clozapine users per month. From December 2020 to November 2022, pharmacist managed 90 default instances that required tracing, with 15 of them failing first attempt tracing and required referral back to Psychiatry department for follow-up.
