For the second year in a row, a team selected for the PHC/VCH Knowledge Translation Challenge will be mentored by a CHÉOS Scientist. Dr. Joseph Puyat joins a team of point-of-care clinicians led by Michelle Carter, a Clinical Nurse Specialist in the Mental Health Program at PHC.
The team aims to implement a clinical toolkit for monitoring people on clozapine, a medication used for treatment-resistant schizophrenia.
The KT Challenge is a regional initiative which is a collaboration between Providence Health Care and Vancouver Coastal Health and is designed to support teams of clinicians who are responsible for moving evidence into practice to improve patient care.
“Clozapine is very effective but carries with it increased risk of side effects compared to other antipsychotics,” said Carter. “This project centers around providing the right tools to clinicians so they can provide safe, effective, and evidence-based care.”
The two primary side effects of clozapine are agranulocytosis, a serious condition that results in a reduced white blood cell count and a compromised immune system, and myocarditis, an inflammatory disease of the heart muscle.
“Consistent and effective monitoring of people on these drugs can mitigate the risk of adverse effects,” added Carter “People with chronic schizophrenia represent a typically marginalized population and we owe it to them to provide the best care possible.”
Specifically, the team will adapt a clinical toolkit that was developed and implemented at St. Paul’s Hospital in 2015 and apply it to Vancouver General Hospital (VGH).
“We saw a few cases of myocarditis which led to an interdisciplinary effort to standardize how we monitor patients on clozapine” said Carter.
The PHC toolkit, which is undergoing its second revision since its implementation, will be adapted to fit within the systems and processes at VGH. The toolkit is made up of six core components:
- Interdisciplinary Guidelines: an evidence-based document that will include discipline-specific directions and actions relating to caring for patients on clozapine, such as monitoring and baseline assessments.
- Pre-printed Orders: a standardized document for physicians, supporting prescribing and bloodwork monitoring.
- Nursing Monitoring Flowsheet: a documentation tool that will prompt nurses to assess patients at set frequencies and improve side effect management
- Discharge Summary: a communication tool that will help inpatient pharmacists relay information about clozapine and monitoring information to primary and community care teams.
- Patient Brochure: a resource to support clinicians’ discussion of side effects with patients in-hospital
- Online Course: a platform for psychiatrists, nurses, and pharmacists to support clozapine-related care and knowledge about the above resources.
The toolkit will be implemented in stages and will include engagement with VGH leadership as well as point of care staff. There are five inpatient psychiatry units at VGH; the introduction of the toolkit will be supported by head nurses, a clinical nurse educator, and pharmacists. Education and training will occur via individual and group sessions and supplemented by the online course.
For his part, Dr. Puyat is involved with the design and evaluation of this project. He will also assist the team with knowledge mobilization and dissemination. Dr. Puyat’s past work has touched on the use of antipsychotics, a class of medication that includes clozapine, in different population groups.
“Dr. Puyat will be invaluable in helping us share our learnings through publications and conference presentations” noted Carter.
“This project is one of the first clinical practice collaborations in psychiatry between PHC and Vancouver Coastal Health — it could provide a blueprint for future regional initiatives,” said Carter. “On top of this, our project is timely as CST [Clinical & Systems Transformation] is on its way. If we can come to clinical consensus on best practice, we will better be able to build the tools we need into our future-state system.”
The KT Challenge is run in partnership with Providence Health Care Professional Practice, Providence Health Care Research Institute, Vancouver Coastal Health Research Institute and VCH Professional Practice, and is supported by funding from PHC, PHCRI and VCHRI. Last year, CHÉOS’ Dr. Martha Mackay served as a team mentor in the inaugural KT Challenge competition.