Quality standard
Quality statement 5: Access to clozapine for treating hallucinations and delusions
Quality statement 5: Access to clozapine for treating hallucinations and delusions
Quality statement
Services for adults with Parkinson's disease provide access to clozapine and patient monitoring for treating hallucinations and delusions.
Rationale
Medicines for Parkinson's disease can cause hallucinations and delusions. If these symptoms of psychosis are not controlled adequately, they can lead to permanent admissions to care homes. It is therefore important that specialist services ensure adults with Parkinson's disease can access clozapine and the required patient monitoring if needed. As specialist Parkinson's services may not be able to provide this directly, they should agree with other local services how access will be provided and ensure that the specific needs of adults with Parkinson's disease (such as the need for a lower dose) are understood and met.
Quality measures
Structure
Evidence of local pathways to provide access to clozapine and patient monitoring for treating hallucinations and delusions in adults with Parkinson's disease.
Data source: Local data collection, for example, service protocol and referral pathways.
Outcome
a) Prescribing rates of lower dose clozapine for adults with Parkinson's.
Data source: Local data collection, for example, Clozaril Patient Monitoring Service.
b) Satisfaction with the management of hallucinations and delusions among adults with Parkinson's disease.
Data source: Local data collection, for example, patient survey.
c) Permanent admissions to care homes for adults with Parkinson's disease and hallucinations or delusions.
Data source: Local data collection, for example, audit of patient health records.
What the quality statement means for different audiences
Service providers (such as hospital elderly care services and neurology services) ensure that adults with Parkinson's disease can access clozapine and patient monitoring for treating hallucinations and delusions. This may mean joint arrangements with mental health services are needed. Providers ensure that healthcare professionals are aware that adults with Parkinson's disease need lower doses of clozapine than adults without Parkinson's disease.
Healthcare professionals (such as neurologists, elderly care consultants and Parkinson's disease nurse specialists) follow local processes to provide access to clozapine and patient monitoring for adults with Parkinson's disease and hallucinations or delusions if needed. If this means a referral to another service, healthcare professionals ensure that the need for a lower dose of clozapine in adults with Parkinson's disease is understood.
Commissioners (such as clinical commissioning groups) commission a clozapine service for adults with Parkinson's disease and hallucinations or delusions that includes monitoring. Commissioners should encourage joint working between services to ensure that the specific needs of adults with Parkinson's disease are understood and met.
Adults with Parkinson's disease and hallucinations or delusions can have treatment with clozapine if they need to. If they start clozapine, they will need to be registered with a monitoring scheme to have regular blood tests.
Source guidance
Parkinson's disease in adults. NICE guideline NG71 (2017), recommendation 1.5.17