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redesign of clozapine clinic (Eileen Rennie, Sue Cameron)
 

Eileen rennie & Sue Cameron
Community Mental Health Nurse
Submitted Date: 19/07/2011
Review Date: 19/01/2012
Overview
Improving the service user's experience whist attending a Clozapine Clinic
Local Area
Grampian
Care Setting
Community care
Care Group
Adults
Evidence Base for Practice
NHS Protocol for Clozapine treatment - clozapine is indicated for use in treatment resistant Schizophtenia

NICE clinical guideline 82 - work in partnership with people with chizophrenia and their carers, offering treatment and care with hope and optimism. Take time to build supportive and empathic relationships.

Integrated Care Pathway - Schizophrenia care Standard 30 service targets include:
- High rates of engagement
-Decrease re-admission
-Decrease use of Mental Health Act
-Decrease critical incidents
-Increase recovery/wellbeing
Quality assurance/impact of practice
Attendance improved. Clients approved of current practice of clinic. There was a more therapeutic alliance between Nurse/Client /Consultant.
Practice Summary
This service aims to improve clients experience while attending the Clozapine Clinic. We had to relocate the Clozapine Clinic and re-establish it in a more clinical setting. We evaluated current practice and identified areas that requiered improvement, these included;
1) Appointment times
2) Continuity of staff
3) Extra training i.e venepucture
This Clinic includes the taking of blood, pysical health checks and assessment of mental health. The primary objective was to make this service Nurse led, to provide continuity of care and to establish a more theraputic nurse/client relationship. The secondary objective was to make the clinic a more structured setting for clients to attend.
Practice Detail
2 Nurses facilitate this clinic
Every client has a planned admission to the Acute Ward under the care of their Consultant to commence Clozapine
Clozapine Nurses informed of clients admission to commence Clozapine
Prior to discharge an appointment to attend the Clozapine Clinic is arranged, and on discharge a referral is made to the Clozapine Clinic to commence ongoing monitoring.
Clozapine Protocol implemented in accordance with clients specific requirements.
Nurse/ client relationship developed at clinic through consistent staffing.
Nurses communication between MDT re Clozapine clients and GP practices.
The Clozapine Clinic has progressed from a walk in clinic to a more structured clinical setting. The Clinic has moved away from an adhoc staff situation to 2 permanent members of staff
Challenges
Lack of Structure
Attendance was sporadic and there was no continuity of staff, patients could turn up on an adhoc basis leading to lack of motivation to attend. No member of staff was taking a definite lead roll.
Additional Comments
It is essential to have a good working relationship with all people involved.
Perseverance was needed to establish a good working practice while fitting into a new setting.
After 3 years we have become a more efficient service resulting in a more satisfying experience for clients.
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