Clozapine Start

Clozapine Start Tile
S A M Clozapine Status
S A M Tool Summary
Clozapine Offer History
Clozapine Baseline Assessment
Assessment Tools
HoNOS
Clozapine Community Initialization
Clozapine Start Details
Clozapine Optimization
Clozapine Discontinuation Details

Clozapine Start Tile

This tile is where the documentation regarding the details of a client on clozapine medication will be entered, reviewed and or updated. This information is meant to be collected over a period of time to assess readiness to start (Offer History), date started, where the initiation occurred, type/brand of medication, and dosage and optimization.

There will only ever be one clozapine form active at any one time. Regardless of staff and or teams that is working on the form. This is a collaborative form so multiple teams and clinicians can contribute to the form throughout the duration of the clozapine trial.

You can also navigate to Assessments and Casenotes within the Clozapine Start form easily by clicking on the Assessment or Case Notes tab at the bottom left hand side of the form:

Clozapine Start Guidance 

There is a purple Guidance button located at the top left hand side of the clozapine start form (see below screenshot). You can use this guidance button to locate guidelines and DST information. Ensure you review all appropriate guidelines and DST's prior to completing the screener.

• DST Clozapine Monitoring and Management in Community: http://shop.healthcarebc.ca/vch/VCHDSTs/D-00-13-30100.pdf
• Psychosis Management Pathway: https://one.vch.ca/dept-project/Mental-Health-and-Substance-Use-Services/Documents/Psychosis-Management-Pathway.pdf

Create a new Clozapine Start Form

1. Click on the Clozapine Start Tile
2. Click the pink Add Form button
3. Select Team you are charting against
4. Choose the applicable form:

• • • • Clozapine Re-Start: Choose this form if a client has been on clozapine in the past but it was discontinued
      • Clozapine Start: Choose this form if a client is starting clozapine for the very first time. NOTE: this form will only ever be used once per client.
      • Currently on Clozapine: This form will only ever be selected once, if you have an existing client who is currently on clozapine. All subsequent trials will be a Re-Start

5. Once you select your form, the form will load
NOTE: You can click on the purple Guidance button anywhere in the form which provides links to the Clinical guidelines

SAM Clozapine Status

This section shows reminds you to review all specific clinical guidelines before starting the form. 
This section also shows you what form you are in (Form Type), the status of the clozapine trial (Form Status), who initially created the form (Recorded By) and who last updated the form (Last updated by).

SAM Tool Screening Summary

This section pulls the SAM Tool Screener information and displays the Initial screening date, diagnosis, screener outcome, screener by and the two Trialed Medications that were entered in the screener. NOTE: The client may have tried more than 2 antipsychotic medications, however the screener only captures the most recent two (those entered in the screener), to see full list of all medications review client's medications as per your teams process.

Clozapine Offer History

This section captures the clozapine offer history. NOTE: If you have selected the Currently on clozapine form, this section will default close and you do not need to enter this information, though it is optional.

1. Click Insert a Row
2. Entry screen will appear:

• • • • Recorded By: Will auto populate to the logged in clinician
      • Team: Select your team
      • Date Recorded: will auto populate Today’s date

3. Complete answers to questions outlining the clozapine offer history. Questions are greyed out initially and will activate as you answer the questions.

• • • • These questions are meant to be reviewed on an ongoing basis to ensure information is current and up to date.

4. As you move through each question, you may Accept Changes and save at any time and return at a later date to provide new responses to your clients offer history. NOTE: The ‘Modify row’ button is only used to mark the row entered in error. If you tick modify row the entry form will be greyed out except the EIE tick box at the bottom. To make changes to your entries, you will click on ‘Insert a row’, then complete the questions again. This is to ensure clinical information about the client is current and up to date.

• • • • For example if your client did not initially accept your offer and then 3 months later you offer again and the client accepts you would click ‘Insert a row’ and fill out the questions again indicating your client has now accepted the offer
      • The grid view displays all the entries so you can quickly see the client’s offer history, allowing the form to be up to date with current information.

Complete Assessments Tools

This section is a reminder to complete assessments as required at intervals as per DST guideline.

The assessment tools can be entered in the assessment grid available below. This grid can be used within the clozapine start tile and in the Assessment Tools application. These entries will flow back and forth.

Assessment Tools

You can enter assessment tools directly into this grid via the ‘Insert a row’ button.

HONOS: Adult And 65+ Assessments [MRR]

This section is a read only grid of previously enter HoNOS assessments that flows from assessments.

In order to enter a new HoNOS, go to the assessments application to enter. HoNOS scores entered there will flow to this grid if entered as a stand-alone assessment or if completed during psychiatric assessments (MHSU assessments).

Clozapine Community Initialization

This section captures how clozapine was initiated. NOTE: If you have selected the Currently on clozapine form, this section will default close and you do not need to enter this information if it unknown.

Clozapine Start Details

This section is to enter the expected date the client will start their first dose of clozapine.

1. To enter the clozapine start information enter the following:

• • • • Clozapine Start Date: Enter the date clozapine medication will start. Click into the field and press F4 on your key board to bring up the calendar. NOTE: If your client is currently on clozapine, and you selected the currently on clozapine form, there are two additional check boxes to indicate estimated or approximate start dates if the clozapine start date is not known. If you tick 'Estimated Start Date?', you are still required to enter a date in order to move forward, following the date format of 01/mm/yyyy.
      • Medication Brand: Provide the clozapine brand by clicking the magnifier to see the available medication brands.
      • Clozapine Registration Identifier: Enter the Clozapine number the client has been assigned for their clozapine initiation. This entry will not flow to the Identifiers grid found in Central Index.

Clozapine Optimization

This section is meant to be reviewed on an ongoing basis to ensure information is current and up to date regarding the clients optimization outcomes.

1. Click on the ‘Insert a row’ button and answer each question:

• • • • Recorded By: Will auto populate logged in staff name
      • Team: Select your team
      • Date Recorded: Will auto populate to todays date, update if needed

2. Continue to answer the questions in the entry screen. NOTE: You may save (Accept Changes) and return at a later date to provide updated responses. To continue you will click on ‘Insert a row’ and you will need to review the questions again and enter updated answers to each question.

The grid view displays all the entries entered so you can quickly see the client’s clozapine optimization over time, allowing the form to be up to date with current information.

Clozapine Discontinuation Details

This section must be completed on the current form, if a client is no longer taking prescribed clozapine medications.

A clinician will not be able to add a new form (a new clozapine trial) until the active form is completed, the discontinuation details are entered and the form is marked as complete, by ticking the ‘Form Complete?’ check box and saving. NOTE: If you try to add a new form when the client already has an active form open, a pop will direct the clinician to complete the active form first. Once this is entered and saved. A clinician may create new by clicking ‘Add Form’ as applicable.

1. Enter the following information after your client has stopped their clozapine trial:

• • • • Clozapine Discontinued on Date: Enter the date the client stopped taking the prescribed clozapine medication. NOTE: If this field is greyed out, ensure you have entered a clozapine start date above. If your client is currently on clozapine, and you selected the currently on clozapine form, and you tick 'Estimated Start Date?' you are still required to enter a date in order to move forward, following the date format of 01/mm/yyyy.
      • Reason for Ending Clozapine: Enter the reason the client stopped taking the prescribed clozapine medication
      • Clozapine Discontinuation Details: Enter any pertinent information as to why the clozapine medication was discontinued
      • Form Complete? Tick this check box when you have entered all applicable information regarding this clozapine trial. NOTE: Once this is ticked and you save, the form will become read only and you will not be able to make any edits to it.

2. After the trial is completed and you have clicked ‘Form Complete?’ and saved, if you are trying an additional clozapine trial you can click Add Form and select CLOZAPINE RE-START.

NOTE: If your client has been lost to contact, moved out of health authority, or has died and you need to close the form in order to discharge your client, you would select ADMINISTRATIVELY DISCONTINUED in the Reason for ending clozapine and then check the Form Complete? check box.