Clozapine REMS Program Update

Well, it’s Friday, the day after the big update to the Clozapine REMS Program website. I don’t notice any major differences. I can navigate it pretty well. I still have a list of patients whose management I’m not responsible for and my contact at the program tells me that’s unlikely to change. That means I get “Alert” messages that I’m not accountable for.

But I’m fretful when I see that they are not being addressed–or startled when I see them disappear. This tends to raise a troubling question at times for me. What, if anything, ought I do when I see that a patient’s Alert is not being dealt with–at least while I’m looking at it? Is that a patient safety issue that I’m bound to report to the Clozapine REMS Program? Should I try to contact the Prescriber?

In one case I did just that! The Alert disappeared even before I was able to connect with the person. If the Alert was for me, it should not have vanished because I didn’t do anything.

It’s a little spooky. Am I an unwitting Peeping Prescriber?

Another row of activities has been stacked above the patient chart, giving me the illusion of control over the list of patients whose management I’m not accountable for, yet whose data is making me think maybe I should be collaborating with a Prescriber or two. All I can do really is sort them differently.

But I cannot remove their names. They beckon me, in a way. In time I’ll learn to not make them my problem. But what if Prescribers are not certified by December 14, 2015? What will happen? I’m told that clozapine dispensing would be unlikely to be abruptly halted. What would probably occur is that the guilty Prescriber would get a nasty note from the FDA. What would happen after that is unclear.

Alcatraz Tour

We’re all referred to as “Prescribers.” That is a very politically chosen egalitarian term for the many different clinicians who have been managing patients on clozapine. They include primary care physicians, neurologists in some cases, nurse practitioners (some of whom may never certify because of the challenges in that complex process), physician assistants as well as psychiatrists.

Despite the many non-psychiatrists out there who manage clozapine, my hospital will allow neither psychiatry residents nor non-psychiatric physicians to write the initial prescriptions for it. Only a psychiatrist who is on faculty can do that. It’s a puzzling hospital policy which is at variance with what actually happens in the world at large.

I discussed the many side effects with my contact at the Clozapine REMS Program (who has been very helpful, by the way). He wondered aloud why neutropenia is the one the program picked to monitor.

It’s the easiest.

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