P18S09: Clozapine adverse effects
Bottom line: Information on Clozapine adverse effects was used to maintain the management of
the patient (no change in medication). It contributed to avoid inappropriate treatment and prevent health
deterioration.
Level 1 outcome (situational relevance): On November 24, 2008, P18 did a search at work, by themselves, and
after an encounter with a patient. P18 reviewed the medication of this patient
with the physician who saw the patient. P18 retrieved two information hits about Clozapine adverse effects. The reported search objectives were: to address a clinical question, to
share information with a patient, to exchange information with other health
professionals, and to manage tasks with other health professionals. “[The patient] is probably in his twenties. He
had taken clozapine for a while actually, maybe six, seven months. And he’s
been an inpatient that long as well. […] He’s schizophrenic but he also has
psychogenic polydipsia where he will drink water continuously. […] Then he
would start to complain that things didn’t taste right, that the water didn’t
taste right, and that the food didn’t taste the same anymore. Part of what we
were trying to decipher is if the medication was probably changing the taste or
if he was trying to manipulate us so the team would let him go and tried to eat
and to give him something else to drink. Because he’s in a restricted volume
diet I guess. Like his water intake was limited because usually he would
continue to drink and then he would end up with low sodium and then he would
have seizures. […] So to more actually share info with the patient that this
drug probably wasn’t causing his taste changes so we had to figure out the
reason was otherwise. […] I also discussed with the physician because he was
worried it was the drug and not the patient.”According to P18, the
information from e-Therapeutics+ was in agreement and equally relevant as the
information from another electronic resource (Up-to-Date). “We
couldn’t find [this adverse effect] anywhere, so.”
Level 2 outcome (cognitive impact): The two hits were associated with a report of
positive cognitive impact (see table). Regarding learning, P18 stated: “I was looking for
taste change, so in the last bit where you can look by body system, I just
looked under GI [gastrointestinal]. And there is nothing there. […] I learned
that it doesn’t make a taste change, so.”
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): e-CPS Tab – Clozaril Monograph – Adverse effects paragraph (P18S09H01)
2) e-Therapeutics+ (CIRT): e-CPS
Tab – Clozaril Monograph – Table 1 on adverse effects (P18S09H02)
Level 3 outcome
(information use): Information on Clozapine adverse effects was retrieved, and used to better
understand a specific issue with respect to the management of the patient, and to
maintain (be more certain about) the management of the patient (information
used as presented in eT+). “I was determined to make sure he [the patient]
stayed on clozapine. […] I made sure that we didn’t need to take him off the
medication. […] So we kept him on the same medication which was good because he
was stable in terms of schizophrenia.”
Level 4 outcome (patient health): Regarding patient
health, P18 reported that the information would avoid inappropriate treatment,
and would prevent health deterioration. “[The
patient] is still on it. He still continues [clozapine]. [...] I wanted him [the doctor] to continue him [the
patient] on the medication because he was stable and doing well, so as to avoid
any changes to the treatment. […] So we had thought that we’d change it because
he had already tried so many other antipsychotics before he got the clozapine,
then I think he would have just been downhill from there. It would have
deteriorated if he had changed to something else.”
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information Manage patient care |
Learned something Confirmed Reassured |
Be more certain Understand issue |
Prevent Avoid |