Prescribing clozapine in the UK: Quality improvement issues identified by clinical audit.

Introduction: The Prescribing Observatory for Mental Health initiated a quality improvement (QI) programme on clozapine use in UK mental health services.

Methods: Clinical audits conducted in 2019 and 2021.

Results: Sixty-three participating NHS Trusts/healthcare organisations in 2019, and 61 in 2021, submitted treatment data for 6948 and 8155 patients, respectively.

Plus ça change? Switching lithium preparations.

Aims And Method: A supply disruption alert in 2020, now rescinded, notified UK prescribers of the planned discontinuation of Priadel (lithium carbonate) tablets. This service evaluation explored lithium dose and plasma levels before and after the switching of lithium brands, in order to determine the interchangeability of different brands of lithium from a pharmacokinetic perspective.

Results: Data on the treatment of 37 patients switched from Priadel tablets were analysed.

The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services.

Background: In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine.

Methods: NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice.

Results: Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations.

Prescribing for moderate or severe unipolar depression in patients under the long-term care of UK adult mental health services.

Background: A quality improvement programme addressing prescribing practice for depression was initiated by the Prescribing Observatory for Mental Health.

Methods: A baseline clinical audit against evidence-based practice standards was conducted in UK adult mental health services.

Results: A total of 55 mental health services submitted data for 2082 patients, under the care of a community psychiatric team (CMHT) for at least a year, with a diagnosis of moderate or severe unipolar depression, 54% of whom had a comorbid psychiatric diagnosis.

Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services.

Background: We aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services.

Methods: The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK.

Results: Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services.