Positive outcomes for Bexley’s Learning Disability Clozapine Clinic

I thought I would write about our Clozapine clinic which the Bexley Community Learning Disability Nurses set up to ensure that our service-users had the right level of reasonable adjustments to meet their health needs

Here’s how we did it…..

I’ll explain a little bit about the background of how Clozapine used to be managed and then the process of how we got to where we are today.

The service-users used to attend another clinic whereby they would have their bloods taken. The phlebotomist would then send the bloods via courier to the central database for Clozapine analysis. The pharmacy would then inform us of the results. This was working ok but there were a few problems and we felt this system was not be-spoke enough to fully meet the individuals health needs and provide detailed assessment.
So….

Wen we moved to Queen Mary’s hospital, we decided to explore the options of setting up our own Clozapine clinic and work jointly with the Phlebotomy Team and agree a workable system. We initially met with the lead phlebotomist and the manager (who were really helpful) to discuss the plans to start the clinic and to highlight some of the individual needs of the service-users who will be required to have the blood tests so that the reasonable adjustments could be applied. Following this we were able to:

• Agree a monthly date for the service-users to attend on a consistent time every month
• Service-users would be fast-tracked and have support from our team to have the bloods taken
• We provided a folder with all the relevant information for each service user including blood stickers, ZTAS number (data base identity), dates of every blood test and the times to expect each individual.
• A training pack was given to the phlebotomy team in relation to learning disabilities and Clozapine management to support the team.

Once this working relationship was established, we were then able to develop the Clozapine clinic protocol.


Clozapine is an antipsychotic drug that is prescribed when other anti-psychotics have not been sufficiently effective. Due to its risk of causing neutropenia, all service-users are required to be registered with a central database and have routine blood tests throughout their treatment. In addition to the risk of neutropenia, there are other side effects which require very close monitoring.

 Therefore our role and function of the clinic ensures that people who are prescribed Clozapine are:

• Supported to have their routine blood tests on their stage of treatment
• Close physical health monitoring using an assessment chart for side effects (Glasgow anti-psychotics side effect scale for clozapine)
• Physical health monitoring conducted including BP, pulse, temperature, weight, waist measurement, active discussion around constipation symptoms and advice, additional blood screening and cardio-investigations requested as appropriate
• Health promotion offered and information shared. All service users have an easy-read information pack regarding Clozapine and information about the clinic which was devised in collaboration with Sharon Rodrigues, ALD Patient Information Lead
• Supported to attend their blood test and given individual blood packs with labels and advocate reasonable adjustments (fast-tracked if required)
• Further discussion and support regarding response to treatment, mental health presentation, medication, dosage and lifestyle changes e.g. smoking/caffeine intake
• Nurses have access to central database and can view/read and act on the results and liaise with pharmacy/service/users accordingly.

Picture of Merci, phlebotomist QMH and Ken, Service-user of clinic

How has it been going?

The clinic has been running now for 6 months. The feedback form that we have devised in an easy read format summarised that:

• All service users were happy that there was a long time slot monthly to discuss their physical and mental health and the monitoring within it
• They were happy that the side effects of Clozapine was assessed every month

Future sustainability

Further outcome measures are going to be developed to monitor and audit its on-going sustainability against NICE guidelines

Thank you for reading this blog. I hope this illustrates an example of good joint working and networking and the importance of close team working. This also is a reflection of how reasonable adjustments have been made in practice and how physical and mental health needs of service-users who are on Clozapine can be fully met in a person-centred way.

I welcome any feedback or comments

Sarah Westrip

Clozapine clinic nurses are Sarah Westrip, Jane Harding, Denzel Mafukidze, Daniel Stratton, and Dr Flynn our Consultant whom we work closely with.