Medicines reconciliation - Mental Health
Clozapine & antipsychotic long acting injections (depot)
The Emergency Care Summary (ECS) for patients with a diagnosis of schizophrenia may show no record of any antipsychotic prescription; this may indicate they are prescribed a specialist medicine such as clozapine or an antipsychotic depot.
Suggested actions:
• Check the Mental Health Summary on Clinical Portal for an alert.
• Check Clinical Portal medicines reconciliation (MR)/Immediate Discharge Letter (IDL) history (check date to ensure information is current).
• Clarify medication with patient/carer, or if unable, check patient's own drugs if available.
• If MR process suggests patient is prescribed clozapine or antipsychotic depot, contact relevant Mental Health Service (MHS) to confirm medication details.
• Leverndale pharmacy should be contacted for confirmation of clozapine treatment, dose, patient blood status and supply to avoid a treatment break and resulting re-titration. Out-of-hours, the Mental Health On-call Pharmacist should be contacted.
• If no alert is present, contact MHS who may help establish whether the ECS/Clinical Portal information is complete.
Antipsychotic information on the ECS
Clozapine is a second generation antipsychotic used for treatment‐resistant schizophrenia. As it has the potential to cause agranulocytosis and neutropenia, there is mandatory registration, blood monitoring, prescribing and dispensing requirements which restrict the supply. All clozapine supplies in NHSGGC are issued from the pharmacy at Leverndale Hospital. While GP practices can record clozapine, and other 'hospital' medicines, on a patient's record as 'Outside Supply', as per NHSGGC Good Practice guidance, it may not always appear on the ECS. This may have been a contributory factor in reports where patients did not get their clozapine prescribed on admission to hospital; resulting in unnecessary admissions to a mental health hospital for re-titration (refer to previous Medicines Update-Clozapine Supply and Missed Doses in Acute).
Antipsychotic information on Clinical Portal
To further improve MR for Mental Health patients, two medicines related alerts ('on clozapine treatment' and 'on depot antipsychotic treatment') were added to the NHSGGC Mental Health Summary on Clinical Portal.
In addition, the MR/IDL system on Clinical Portal also contains entries for clozapine or depot antipsychotics where patients have been admitted or discharged since the introduction of that system.
What to do if you suspect a patient is prescribed a specialist medicine:
If there is reason to suspect that a patient is prescribed either clozapine or an antipsychotic depot, follow the advice below:
1. Access their record on Clinical Portal.
2. Check the MR/IDL system for information from previous admissions.
3. Open the NHSGGC Mental Health Summary.
Please note: A 'highly sensitive information' warning will appear; healthcare professionals, involved in the care of the patient, should click 'continue'.
4. Check for the presence of an alert that indicates they are either on clozapine or an antipsychotic depot:
5. If Clinical Portal indicates clozapine has been prescribed, contact Leverndale Pharmacy (0141 211 6525) during working hours for confirmation of dose, supply and patient blood status. Out of hours, contact the Mental Health On-Call Pharmacy Team via Leverndale switchboard (0141 211 8300).
6. If an antipsychotic depot alert is present, contact the relevant Community Mental Health Team (detailed in the Mental Health Summary) to confirm the drug, dose and next due date.
7. Please note that the absence of an alert does not confirm the absence of an antipsychotic prescription. It may be possible to clarify by contacting MHS.
Published 28/08/2020. Medicines Update blogs are correct at the time of publication.