Covid-19 may result in patients self-isolating and being unable to attend for their full blood counts or being reluctant to travel to clinics for sampling. Similarly there may be staffing issues that mean it becomes very difficult to maintain normal clinic approaches. In both instances a pragmatic approach is required that supports patient safety with regards to clozapine monitoring but also reflects the realities of the Covid-19 outbreak.
- Patients with a fever: IMMEDIATELY test for both agranulocytosis and Covid-19 especially if they are also showing others signs of these conditions e.g. coughing, sore throat, shortness of breath and a runny nose
- For patients self-isolating: use the maximum validity possible between blood samples i.e.
- Weekly patients 14 days. Mylan apply a 10 day validity to samples but we have 10 years experience of applying 14 days so the increased risk is acceptable. Note treatment from day 10 – 14 with Clozaril would be unlicensed
- Fortnightly patients 21 days
- 4 weekly patients 42 days.
Given the current isolation advice this should support on-going dispensing in most instances.
- For patients who can’t or won’t travel to their usual blood sampling location:
- Strongly urge patients to attend as normal
- Use the maximum validity possible between blood samples
- Consider undertaking blood sampling in patients’ homes.
- Services unable to undertake normal blood sampling processes:
- If it proves impossible for services to undertake normal blood sampling processes consider dispensing off license without blood testing. This will require support from CPMS, DMS & ZTAS and board level governance approval.
- Please record any actions taken on EMIS and inform pharmacy of any delays in blood testing.