{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T22:33:17Z","timestamp":1788906797908,"version":"build-2803163510"},"reference-count":25,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T00:00:00Z","timestamp":1655078400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Prescribing Observatory for Mental Health is funded solely through subscriptions from member healthcare organisations (principally NHS Trusts)."}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Psychopharmacol"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The Prescribing Observatory for Mental Health initiated a quality improvement (QI) programme on clozapine use in UK mental health services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Clinical audits conducted in 2019 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Sixty-three participating NHS Trusts\/healthcare organisations in 2019, and 61 in 2021, submitted treatment data for 6948 and 8155 patients, respectively. In both audits, high-dose and\/or combined antipsychotic medications had been prescribed immediately before initiating clozapine in over a quarter of patients recently started on clozapine. In patients who were tobacco smokers and recently discharged from a smoke-free ward, the impact of the potential change in smoking status had been considered in the care plans of just under one-third in 2019 and just over a half in 2021. For community patients, their Summary Care Records (SCRs) included their clozapine prescriptions in 58% of cases in 2019 and 72% in 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Three QI issues were identified. (1) Antipsychotic regimens with limited evidence for efficacy in treatment-resistant schizophrenia were prescribed for over a quarter of cases before starting clozapine. Use of such strategies may delay clozapine treatment, potentially reducing the likelihood of a therapeutic response. (2) While anticipation of the consequences of a change in smoking status on plasma clozapine concentration following discharge from hospital showed improvement over time, even in 2021 it was not evident for nearly a half of relevant cases. (3) While inclusion of clozapine in the SCR also improved over time, even in 2021 it was missing for more than a quarter of community patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02698811221104060","type":"journal-article","created":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T06:03:37Z","timestamp":1655100217000},"page":"1036-1040","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Prescribing clozapine in the UK: Quality improvement issues identified by clinical audit"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2324-656X","authenticated-orcid":false,"given":"Thomas RE","family":"Barnes","sequence":"first","affiliation":[{"name":"Division of Psychiatry, Imperial College London, London, UK"},{"name":"Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6754-1018","authenticated-orcid":false,"given":"James H","family":"MacCabe","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"},{"name":"NIHR Maudsley Biomedical Research Centre, London, UK"},{"name":"Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"Kane","sequence":"additional","affiliation":[{"name":"Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Hempstead, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Delgado","sequence":"additional","affiliation":[{"name":"Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mareeha","family":"Khan","sequence":"additional","affiliation":[{"name":"Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-1031","authenticated-orcid":false,"given":"Carol","family":"Paton","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, Imperial College London, London, UK"},{"name":"Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,6,13]]},"reference":[{"key":"bibr1-02698811221104060","doi-asserted-by":"publisher","DOI":"10.1177\/2045125320937908"},{"key":"bibr2-02698811221104060","doi-asserted-by":"publisher","DOI":"10.1177\/0269881119889296"},{"key":"bibr3-02698811221104060","first-page":"306","author":"Butterworth S","year":"2021","journal-title":"Pharm J"},{"key":"bibr4-02698811221104060","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200115060-00005"},{"key":"bibr5-02698811221104060","unstructured":"Evans K, Oza D, Hewitt K (2019) Reducing the risk of clozapine patient harm by correcting summary care records using a \u2018Continuous Quality Improvement\u2019 approach (poster). Lincolnshire Partnership NHS Foundation Trust. Available at: https:\/\/fabnhsstuff.net\/storage\/CMHP-poster1V4-5da59c5c4dbe4 (accessed 1 June 2022)."},{"key":"bibr6-02698811221104060","doi-asserted-by":"publisher","DOI":"10.17265\/2159-5313\/2016.09.003"},{"key":"bibr7-02698811221104060","unstructured":"Health Research Authority (2017) Do I need NHS REC review? Decision tool. Available at: http:\/\/www.hra-decisiontools.org.uk\/research\/docs\/DefiningResearchTable_Oct2017-1.pdf (accessed 1 June 2022)."},{"key":"bibr8-02698811221104060","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.105833"},{"key":"bibr9-02698811221104060","volume-title":"IBM SPSS Statistics for Windows, Version 21.0","author":"IBM Corp","year":"2012"},{"key":"bibr10-02698811221104060","unstructured":"Joint Formulary Committee (2021) British National Formulary (online). London: BMJ Group and Pharmaceutical Press. Available at: https:\/\/bnf.nice.org.uk (accessed 2 September 2021)."},{"key":"bibr11-02698811221104060","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp060414"},{"key":"bibr12-02698811221104060","unstructured":"National Institute for Health and Care Excellence (2014) Psychosis and Schizophrenia in Adults: Prevention and Management. NICE Clinical Guideline 178. London: National Institute for Health and Care Excellence."},{"key":"bibr13-02698811221104060","unstructured":"NHS Digital (2020) Summary care records. Available at: https:\/\/digital.nhs.uk\/services\/summary-care-records-scr#using-scr (accessed 16 December 2020)."},{"key":"bibr14-02698811221104060","unstructured":"Pan Mersey Area Prescribing Committee (2019) Summary care record: Minimising harm from missing data. Safety statement, version 1.1. 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