Clozapine is an atypical antipsychotic used mainly in treatment resistant schizophrenia. Clozapine is known to have various side effects including neutropenia, agranulocytosis, constipation, hypersalivation, myoclonus, tachycardia, dry mouth, gastrointestinal reflux, and hypotension. Therefore, it is important that patients have regular monitoring of their physical health through blood tests and side effect monitoring. The Glasgow anti-psychotic side effect questionnaire allows patients to report side effects whilst on clozapine. This can then be used to review patients’ symptoms and treat them as required. The aim of our project was to review compliance of current blood monitoring of patients on clozapine with NICE guidelines and elucidate the effectiveness of the Glasgow anti-psychotic questionnaire in reporting of side-effects. Thirdly, we aimed to introduce a robust new monitoring system to ensure that clozapine monitoring was optimum.

Compliance of the current blood monitoring was checked by reviewing the blood results for all 68 patients on clozapine. The latest blood results were compared to observe if they were within the required timeframe as per NICE. Secondly, the Glasgow antipsychotic questionnaire was distributed to patients on clozapine and then data collated. Following, this a new computer spreadsheet monitoring system was introduced to improve compliance. This allowed patients with overdue monitoring to be flagged up.

The overall compliance for the various blood parameters varied from 3% to 100% (glucose- 3%, prolactin- 19%, lipid profile- 68%, HbA1c- 69%, liver function- 72%, renal function- 74%, and full blood count- 100%). Following the introduction of a new monitoring system the overall compliance improved as follows (glucose- 8%, prolactin- 32%, lipid profile- 81%, HbA1c- 61%, liver function- 90%, renal function- 88% and full blood count- 100%). We observed a 41% uptake of the Glasgow antipsychotic questionnaire. The most common reported side effects included hypersalivation (86%), GI side effects (nausea and gastric reflux- 64%), postural hypotension (56%) and anticholinergic side effects (blurry vision and dry mouth- 46%).

The findings show that the previous system was not effective. The introduction of a computer-based spreadsheet to flag up patients for clozapine monitoring has substantiality improved compliance with guidelines. The Glasgow anti-psychotic self-reporting questionnaire is effective in allowing patients to report the symptoms that they are experiencing. These changes continue to be utilised in our team.