Quality standard

Quality statement 4: Treatment with clozapine

Quality statement 4: Treatment with clozapine

Quality statement

Adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs are offered clozapine.

Rationale

Clozapine is the only drug with established efficacy in reducing symptoms and the risk of relapse for adults with treatment‑resistant schizophrenia. It is licensed only for use in service users whose schizophrenia has not responded to, or who are intolerant of, conventional antipsychotic drugs.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotics drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic) are offered clozapine.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

Process

Proportion of adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic) who receive clozapine.

Numerator – the number in the denominator who receive clozapine.

Denominator – the number of adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic).

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Relapse rates of schizophrenia in adults.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices, community health services, mental health services and hospitals) ensure that there are procedures and protocols in place to monitor the prescribing of clozapine for adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic).

Healthcare professionals ensure that adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic) are offered clozapine.

Commissioners monitor rates of prescribing of clozapine and commission services only from providers who can demonstrate that they have procedures and protocols in place to monitor this prescribing.

Adults with schizophrenia that has not improved after treatment with at least 2 different antipsychotic drugs are offered an antipsychotic drug called clozapine to try and improve their symptoms.

Definitions of terms used in this quality statement

Schizophrenia that has not responded adequately to treatment

Schizophrenia that has not improved despite the sequential use of adequate doses of at least 2 different antipsychotic drugs. At least 1 of the drugs should be a non‑clozapine second‑generation antipsychotic. [NICE's guideline on psychosis and schizophrenia in adults, recommendation 1.5.7.2]