Introducing a Systematic Approach to Clozapine Monitoring in a Community (Adult) Mental Health Service

Change management is now considered a core managerial competency. Under the fiscal and regulatory environment that currently applies, healthcare managers and professionals must be competent in initiating, guiding and managing change to drive efficient and effective delivery of care.

This dissertation describes a successful journey through a planned change effort. An evidence-based approach to monitoring adverse effects of clozapine was implemented in a Community (Adult) Mental health Team. Clozapine has the sole license for treatment-resistant schizophrenia, but has been associated with several potentially life-threatening adverse effects. Accumulating evidence suggests that not enough attention is paid to recognising and addressing these adverse effects, a finding replicated in an internal audit of practice within this service. Additional external regulatory imperatives provided further impetus for change.

The change was implemented using the HSE change model as a guiding tool. A range of qualitative and quantitative tools that were used to evaluate the change revealed successful attainment of set objectives, and also identified early signs for long term sustenance and continuous quality improvements.

On reflection, the challenges encountered during this project have had considerable formative impact on the learning and practice of the author. It is hoped that future service evaluations will confirm attainment of its intended long term impact, while also providing objective bases for further continuous quality improvement initiatives.