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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV1132

A clinical audit of the assessment and management of clozapine-induced constipation at CNTW

AN AUDIT OF THE ASSESSMENT AND MANAGEMENT OF CLOZAPINE-INDUCED CONSTIPATION IN CNTW

Compliance with routine bowel monitoring is high among patients taking clozapine, but documented escalation of identified abnormal bowel findings occurs in fewer than one-third of patients requiring it.

The aim of the audit was to measure compliance with CNTW NHS Foundation Trust (United Kingdom) standards for the assessment and management of clozapine-induced constipation (CIC), particularly the criteria in PPT-PGN-05 and the CNTW(C)38 Pharmacological Therapies Policy. The poster states that CIC is a potentially fatal adverse effect of clozapine, the most effective treatment for treatment-resistant schizophrenia, affecting up to 60% of patients and potentially leading to severe complications such as bowel obstruction, paralytic ileus, ischaemia and perforation. The electronic records of 80 patients randomly selected from those prescribed clozapine at CNTW, with 20 patients from each locality, were retrospectively reviewed during the audit period from 20/10/25 to 03/11/25. The clozapine monitoring form had been completed for 94% of patients, and the bowel habit section for 96%; where the latter had not been completed, questions about bowel movements were recorded in the progress notes in 33% of cases. Two patients (2.5% of the audit sample) had not been asked about bowel changes at all, which was considered a serious patient safety concern because missed cases of CIC increase the risk of morbidity and mortality. Documented changes included fewer than three bowel movements per week in 11%, hard stools (Bristol types 1/2) in 10%, and diarrhoea (types 6/7) in 6%; overall, changes in bowel habits were identified in 22.5% of patients. Among patients with any change in bowel movements, the documented escalation rate was 28% (5 of 18 patients), which was considered inadequate; it was noted that this might underestimate actual escalation because of incomplete documentation or changes that had already been managed. The audit concluded that routine bowel monitoring was being conducted to a high standard, but that targeted quality improvement initiatives were needed to strengthen escalation processes. Planned actions include multidisciplinary training and CAS alerts, modifying the electronic RiO monitoring form to prompt documentation of escalation, educational posters in clozapine clinics, and repeating the audit. The limitations listed were the retrospective design, sample size, the potential impact of incomplete documentation on the findings, and confounding variables affecting bowel habits.

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