Intended for healthcare professionals

Letters Clozapine deaths

Clozapine deaths: monitoring adverse drug reactions

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l482 (Published 04 February 2019) Cite this as: BMJ 2019;364:l482
  1. Sue Jordan, professor of health services research1,
  2. David Hughes, professor in health policy2
  1. 1Department of Nursing, Swansea University, Swansea SA2 8PP, UK
  2. 2Department of Public Health and Policy Studies, Swansea University, Swansea, UK
  1. s.e.jordan{at}swansea.ac.uk

The reporting and excellent responses to the tragic deaths caused by the side effects of clozapine1 represent ongoing concerns about the quality of patient monitoring, rather than the quality of prescribing. In acute mental healthcare234 and other settings,5 we have shown that the introduction of thorough, structured checks by nurses and care staff can identify problems related to antipsychotics and prompt preventive action. We developed an intervention 67 to facilitate nurse led review of patients with serious mental illness, which pre-empted serious adverse reactions, including chest pain and pancreatitis.2 Monitoring takes 10-20 minutes for each patient, including checks of vital signs, and causes no harm.25 Although it does take the time of frontline staff (nurses and carers), recording constipation, hypersalivation, behaviour change, weight gain, and other problems on a single sheet shared with prescribers and pharmacists can bring real benefits by preventing escalation.

Failure to recognise adverse drug reactions is often due to their complexity and diversity. Such reactions to prescribed drugs often develop after the prescriber has left, so we need a mechanism for transferring information from patient to prescriber, across geographical and social distance. Comprehensive, nurse led monitoring with supporting information has the potential to bridge this gap in communication and care. Adverse drug reactions may contribute to the 5-8% of hospital admissions that are unplanned.89 Adopting structured instruments for monitoring adverse drug reactions,6 for example in monthly haematological monitoring clinics, has the potential to prevent recurrence of the tragic cases described here.

Footnotes

  • Competing interests: There is no commercial interest. We are the authors of the instrument described. This is free to those wishing to use it for patient benefit. http://www.swansea.ac.uk/adre/

References