Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Lo CF(1), Tai WK(1), Ki SY(1), Shum YK(1), Chan HC(1), Lam YL(1)
Affiliation :
(1) Department of Psychiatry, Tai Po Hospital
Introduction :
Clozapine is the only FDA-approved antipsychotic used in treatment-resistant schizophrenia, carries the risks of fatal agranulocytosis. Regular complete blood count with differential count (CBC+D/C) with is essential to detect of any drop in neutrophil count early. It is crucial to ensure that the blood taking is on schedule and the result is within normal range by monitoring system. To enhance the efficiency of monitoring and minimize human errors, the monitoring system is revised and the manual checking method is substituted by utilization of data from the help of the NTEC statistic team. Besides, patients are empowered for self-management of clozapine to enhance medication safety.
Objectives :
1. Facilitate communication about clozapine related blood taking among doctors and nurses 2. Empower patients’ self-management of clozapine 3. Establish monitoring system to substitute manual checking
Methodology :
4M1E method (Man, Mechanism, Material, Method and Environment) was adopted to analysis the implementation and identify areas for enhancement. For enhancing staff communication, a remark related to the patient’s schedule for taking CBC+D/C was added to the clozapine prescription in IPMOE for easy reference. For patient empowerment, a blood-taking record with side effects of clozapine was developed for patients to record the date of blood taking and side effects. It facilitates their communication with doctors and nurses and their monitoring on own blood-taking. For material, a medication monitoring reminder with blood monitoring schedule and standard clozapine related patient care was developed for nurses. For the monitoring mechanism and method, a list of patients having clozapine and their latest CBC+D/C taking date was assessed weekly with the help of the NTEC statistic team. Data was used by supervisors in a self-developed and standardized Excel template with a pre-set formula to identify any blood taking overdue by the automatic date counting function.
Result & Outcome :
Doctors and nurses can identify patients’ blood-taking schedules by the remark in IPMOE during drug review, prescription and blood monitoring. Also, Patients agree that the blood taking record could facilitate their monitoring. The patient list sorted by the statistics team helps supervisors identify patients with clozapine in their ward accurately and efficiently. The checking time consumed is reduced from around 20 minutes to within 5 minutes. Importantly, since the enhancement, there have been no incident related to blood monitoring on clozapine.
