Implementing a Nurse Led

Clozapine Clinic within an Early

Intervention Service

Linda Mora and Niki Garland

Orygen Youth Health

Australia’s largest youth

mental health service

Working with young people

aged 15 – 25 years, across

Melbourne’s north-west

9 Councils and 120 postcodes

Approx. 2500 calls to triage

annually and approx. 75% are

referred to EPPIC

BoroondaraWhitehorse

StonningtonPort Phillip

MelbourneYarra

Manningham

Kingston

Bayside

Greater Dandenong

Yarra Ranges

Monash KnoxGlen Eira

Maribyrnong

DarebinMoreland

Hume

BrimbankMelton

Nillumbik

Cardinia

Banyule

Casey

Frankston

Hobsons Bay

Maroondah

Moonee Valley

Mornington Peninsula

Whittlesea

Wyndham

Child & Adolescent Mental Health Service AreaMetropolitan Melbourne

LEGENDEasternInner SouthernNorth EasternNorth WesternSouth EastLocal Government Areas

Bass Coast

Original: Mental health areas metro.WOR :: MAP: Child

with exceptions at Inner Southern/South East border

Produced by Paula Morrissey, Metro Health & Aged Care

Mental Health Service Areas derived from: Local Government Areas & Statistical Local Areas Australian Standard Geographical Classification (ASGC) 2003

UPDATED: 24/11/06

Orygen Youth Health Clinical Program

Acute Services

Inpatient Unit

YAT

Continuing CareEPPIC

PACE

Youth Mood Clinic

HYPE

Outreach

Psychosocial RecoveryGroup Program

Voc/Ed Recovery

Family Peer Support

Peer Support

Platform

EPPIC: Early Psychosis Prevention and Intervention Centre

EPPIC is part of 4 specialty clinics within Orygen Youth Health 15 – 25 year olds with a psychotic disorderIncludes First Episode Psychosis, Substance Induced Psychosis, Psychosis NOS, Bipolar Affective Disorder with psychotic features, Depression with psychotic featuresCo-morbid diagnoses: ASD, Personality disorders, Anxiety, Intellectual DisabilityTreatment period of 18 – 24 monthsMultidisciplinary team including psychiatrist, registrars, nurses, psychologists, occupational therapist, social workers and family workersFamily and peer support workers

Why Develop a Clozapine Clinic?Accessible for clients

Provide education for clients and families

Provide specialist knowledge about clozapine, its side effects and

response

Provide structured monitoring and support for clients and their families

Ensure thorough and regular metabolic monitoring is completed

Referrals for appropriate investigations are completed and followed up

Reduce the stigma about clozapine, within the team and wider

community

Challenge the idea of recovery - symptoms and functioning can improve

The In’s and Out’s of Clozapine Clinic

Senior Nurse, Psychiatric Registrar and Sessional Consultant

Occurs weekly

Pre-Clozapine workup

Commence clozapine in community settings

Monitor mental state and symptoms

Monitor functioning

Monitor side effects and metabolic monitoring

Assessing clients experience of clozapine

Linkages with GP, Pharmacies, Pathology and external investigations (ECHO), cardiology

Orientation of new registrars every 6 months

Metabolic Data

Our Hypothesis: When clients symptoms and functioning improve, they become more active and their physical

health can improve

Weight Monitoring over 18 Weeks

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Weight BaselineWeight 18 weeks

Waist Circumference

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Waist BaselineWaist 18 Weeks

Barriers and EnablersEnablers Barriers• Support from the team, including

lead consultants• Time constraints and protecting

time for clinic• Specialist clozapine support from

sessional consultant• 6 monthly rotation of registrars

• Passion and dedication of the clozapine nurses

• Experience of rotating registrars

• Commitment from clients and their families

• Nocte doses, lower doses of clozapine

• No cost to clients

Where to from here?Continue to review our protocols

Streamline our response over 3 sites, including the inpatient unit

Build external relationships with agencies, including GP, Pathology,

Pharmacies

“The Wellness Clinic”

Develop a clinic with incorporates specialist nursing, medical advice,

exercise physiologist and dietitian

Develop resources for clients and families

Implement in 2 community sites

Questions?