Clozapine Dispensing Information for Community Pharmacists
Your queries and feedback told us that juggling the timing of blood tests requirements and dispensing protocols for indivuals prescribed Clozapine can be difficult.
You also told us that this can be extra challenging when dispensing in compliance packaging and to residential care facilities.
Ways that this could be improved for you have been explored but each possible work-around jeopardised the protection provided by the dispensing and testing Clozapine Protocol.
To ensure the safety of all individuals prescribed Clozapine, you must follow the Clozapine Protocol outlined in Schedule C2 of your Community Pharmacy Services Agreement and the guidelines provided by the hospital/health service protocol and/or your supplier/manufacturer.
The best and safest solution is to work with the individual’s Multi-Disciplinary Team (MDT) and/or their residential care facility manager to ensure the dispensing cycle and tests align. See the tips to support you.
Remember - Dispensing should generally take place within 24-72 hours of the date of the most recent blood test for the relevant individual. This requirement may vary according to the hospital or health service protocol that applies in your locality. You will need to customise procedures for your pharmacy accordingly.
What you need to be doing?
- Register the individual in your medicines supplier’s monitoring website
- Record the date of each Clozapine dispensing in your suppliers website
- Adhere to the national or local Clozapine Protocols.
Each of the above actions are outlined in the Clozapine Protocols (1.12) to ensure that individuals' Clozapine dispensing is recorded and can be monitored and viewed by the prescriber and MDT to make sure there is continuity of care.
To maintain the continuity of supply of Clozapine for each individual, improve your workflow and promote your clinical value with the MDT use the following tips:
1. Proactive care - Strengthen the relationship with the MDT by proactively monitoring and care planning for the individual. Proactive care means making sure you become an active member of the MDT that anticipates and plans for problems.
Ways you can provide proactive care:
- Set up reminder systems for you, your patient and their MDT about the impending need for a blood test or new prescription to ensure smooth delivery of care
- Check the individual’s blood tests before their next dispensing. You could do this before they present their Clozapine prescription. This way you can have an early conversation with their MDT when blood tests are overdue or causing concern.
- Plan ahead for any possible disruptive issues that individual might encounter and contact their prescriber to prevent this.
- Contact the individual's prescriber to discuss and agree contingency plans if blood test history suggests
- impending neutropenia (because they are trending down or classed as an amber)
- or neutropenia (a red result).
2. Assess their eligibility for registration into the Long Term Conditions Service (LTC).
If you spend a significant amount of time with this individual managing their access and adherence to medication, they may qualify for this Service based on medicines adherence issues.
Recognising there are issues with Clozapine dispensing is the first of an ongoing conversation that needs to happen with MDTs .
The Pharmaceutical Society of New Zealand will be running this as a project. The first step will be engagement with providers.
Contact the Pharmaceutical Society of New Zealand for more information.