Preventing Pneumonia in Clozapine Patients: Pharmaceutical Interventions in a Community Mental Health Setting

Cheshire and Wirral Partnership NHS Foundation Trust

Project summary

Patients on clozapine are at higher risk of infection with an increased likelihood of pneumonia development during the winter months. Contributing factors include cold homes, hypersalivation, respiratory co-morbidities, and lifestyle habits such as smoking. In July 2019, the World Health Organization reported 6,893 cases of pneumonia in clozapine patients, with a mortality rate of 30%. A service development was undertaken to identify clozapine patients most at risk of developing pneumonia during the winter and ensure they received a face-to-face consultation with a pharmacist NMP to discuss interventions and strategies for maintaining their health throughout the season. 

The Trust’s clozapine business intelligence dashboard was used to identify patients under the Wirral Community Mental Health Team (CMHT) who had a home heating status rated ‘poor’ or ‘very poor’ (via Energy Performance Certificate) to create the 25-patient cohort. Each patient was then reviewed to identify if they had further risk factors such as: hypersalivation, respiratory co-morbidity or reported to be a smoker. 

Clozapine clinic appointment dates were coordinated to create a pharmacist consultation schedule, with a room reserved next to clozapine clinic from December 2024 to mid-January 2025; allowing for face-to-face consultations while patients awaited blood results with minimal disruption to patient routine. Each patient was asked for consent prior to participating in the consultation. 

25 patients were identified,19 had clozapine appointments within the project time frame, 12 patients consented to pharmacist consultation. Intervention topics covered included: smoking cessation, inhaler technique, vaccination review, hypersalivation review, advice for staying warm in the winter and red flag symptoms for chest infections. A total of 69 winter interventions were implemented to minimise the risk of pneumonia, and a further 4 to aid adverse effects of psychotropics, resulting in an overall total of 73 interventions made. Consultations were well received by patients and allowed for further discussion of treatment management (e.g., constipation) where pharmacist intervention proved valuable as prescriptions could be issued at the time of consultation. These findings highlight the active role of pharmacist consultations in supporting patient care, addressing both physical and psychiatric health.