| DESCRIPTION OF ENHANCEMENTS |
Recent changes in the Clozapine protocol require changes to the Clozapine
in the past.
Enter the type of the test for Clozapine: WHITE BLOOD COUNT
Enter the reporting method of the test for Clozapine: ?
Enter a code from the list.
Select one of the following:
0 uL
1 K/uL
2 Percent
Enter the reporting method of the test for Clozapine: 2 Percent
Enter the name of the test for Clozapine:
The FDA (Food and Drug Administration) uses White Blood Cell Count and
Absolute Neutrophil Count as the definitive tests to verify for Clozapine
use, however your lab may report your data under any of the names you
enter into these lists. If the WBC and ANC are not directly available,
The weekly roll-up creates a report that is sent to the local G.PSOCLOZ
ANC will be calculated from the other data available and presented to
Pharmacy (and CPRS (Computerized Patient Record System) during a later
revision) at the time of dispense and used to evaluate the safety under
FDA limits. Only the most recent WBC will be accepted, and the date and
time stamp of the Neutrophil count must match the date and time stamp of
the WBC.
WHITE BLOOD CELL (WBC)
mail group. This report lists the patients reported to the national
For reference "White Blood Cell Count" is a portion of the total blood
content and the sum total of two different kinds of cells -
AGRANULOCYTES - those cells which do not have granules
that absorb a stain. These cells are subdivided
into Lymphocytes and Monocytes.
GRANULOCYTES -- those cells which contain granules
that absorb a stain. These cells are subdivided
into Neutrophils, Basophils, and Eosinophils.
database along with an indicator showing whether or not Lab and RX data
Both Agranulocytes and Granulocytes are part of the Total White Blood
Cell Count. Therefore, the total WBC is the sum of five different types
of cells.
WBC as well as its five components are usually expressed as the total
number of cells in a cubic centimeter of blood (cc) or cubic millimeter
(cu mm or mm-3)or milliliters (mL).
WBC usually falls with a range between 4000 and 11,000 but fluctuates for
were transmitted. This report has been updated to show the date of the
a number of medical reasons. For brevity, WBC results may be divided by
1000 and presented as K/cc or K/cu mm or K/mm-3 or K/mL
The five components are similarly expressed as number of the same type OR
as a percentage of the total WBC.
The sum of counts of the five components of should equal the total WBC OR
the sum of the percentages of the five components should equal 100%
most recent WBC (White Blood Count) and Neutrophil Count along with the
This test is sometimes also referred to as "Leukocyte Count"
Absolute Neutrophil Count (ANC)
The Absolute Neutrophil Count is the total number of Neutrophil cells in
the total WBC count. The other GRANULOCYTE cells - Basophils and
Eosinophils (see White Blood Cell Count above) - are not included in this
number. Therefore - a test titled GRANULOCYTES - may not produce the
desired result as it may include Basophils and Eosinophils.
date of the most recent Clozapine prescription. Mental Health and
Since the ANC is a portion of the WBC, it is only valid if it is
traceable to the WBC sample drawn at the same date and time.
ANC is a count and not a percentage - expressed as WBC with the total
number of cells in a cubic centimeter of blood (cc) or cubic millimeter
(cu mm or mm-3)or milliliters (mL). Again, this number may be divided by
a thousand for brevity.
The Absolute Neutrophil Count generally ranges from 1600 to 7700 / but it
Pharmacy personnel responsible for prescribing and dispensing Clozapine
can ever exceed the WBC count.
This test can also be knows as polymorphonuclear cells or PMN's.
Neutrophil Percent (Neut%)
The Neutrophil Percent is the portion of the total WBC and that is
composed of Neutrophil cells, excluding all agranulocytes and other
granulocytes. This number is usually between 40% and 70%, but fluctuates
should be made aware of this mail group and given the opportunity to join.
for many medical reasons.
Since it is reported as a portion of the total WBC, it is only valid if
it is traceable to the WBC sample drawn at the same date and time.
Neut% is commonly obtained by automatic testing equipment to represent
the Neutrophil content in the blood.
Neut% is a percentage and not a count - reported in the portion of the
WBC. It can be converted into an Absolute Neutrophil Count in the
Roll Up software. Originally, all Clozapine prescriptions were limited
following formula (Neutrophil% / 100) X WBC count).
The Neutrophil Percent generally ranges from 37% to 80% and should never
exceed 90% of the total WBC count unless special medical conditions are
present.
SEGS & BANDS
The WBC/Granulocyte/Neutrophil cell type can be further subdivided into
NEW OPTION:
two types. Mature neutrophils are called SEGS. Immature neutrophils
called BANDS also circulate in the blood until they mature into SEGS.
The sum of SEGS and BANDS is equal to the ANC of a give WBC count.
SEGS and BANDS may be reported as a count, expressed in cc, mm-3, cu mm,
or mL. A preceding K indicates the number has been divided by 1000.
When SEGS and BANDS are reported as a number, the sum total of SEGS and
BANDS equals the total Neutrophil Count (ANC) NOTE that the program
needs an identifying test for both SEGS and BANDS. Reporting SEGS
==========
without a parallel result from BANDS will result in an error condition
that may prevent Pharmacy dispense.
This number generally ranges between 1600 and 7700 / cu mm. It should
never exceed 90% of the total WBC except under special circumstances.
SEGS and BANDS may be reported as a PERCENTAGE of the total WBC.
Therefore the total number of neutrophils (ANC) in a give WBC is = total
WBC X (% Segs + % Bands). This calculation will be performed by the
Pharmacy patch to obtain and ANC when necessary
The Link Multiple Tests to Clozapine [CLOZAPINE MULTI TEST LINK] option
The sum total of SEGS% and BANDS% can never exceed 100.
DATA DICTIONARY:
===============
CLOZAPINE PATIENT LIST File (#603.01), OVERRIDE DATE field (#3) - This
field was added to allow the NCCC more control over the overrides
performed at the site.
CLOZAPINE PARAMETERS File (#603.03), LOCK DOWN field (#7) - This field
must be assigned to the person or persons responsible for ensuring that
was added to allow the NCCC to prevent the dispensing of any Clozapine
prescription at a site.
CLOZAPINE TESTS file (#603.04) - This file was added to allow the sites
to select multiple tests for the WBC and Neutrophil count.
Field Field Name Description
603.04,.01 NAME 0;1 FREE TEXT (Required)
603.04,1 TEST NAME 1;0 POINTER Multiple #603.41
the appropriate data is in place to validate Clozapine testing data.
603.41,.01 TEST NAME 0;1 POINTER TO LABORATORY TEST FILE (#60)
603.41,1 TEST TYPE 0;2 SET (Required)
'W' FOR WHITE BLOOD COUNT;
'A' FOR ABSOLUTE NEUTROPHIL COUNT;
'N' FOR NEUTROPHIL PERCENT;
'S' FOR SEGS %;
'B' FOR BANDS %;
'T' FOR BANDS ABSOLUTE;
'C' FOR SEGS ABSOLUTE;
This is usually the Laboratory ADPAC.
603.41,2 REPORTING FORMAT 0;3 SET (Required)
'0' FOR Units;
'1' FOR K/units;
'2' FOR Percentage;
INSTALLATION TIME FRAME:
=======================
VA DIRECTIVE 2001-023 REQUIRES INSTALLATION OF THIS PATCH WITHIN 30 DAYS
FROM THE TIME OF INITIAL RELEASE.
REQUESTING SITE:
===============
National Clozapine Coordinating Center
Test Site(s):
============
West LA
Oklahoma
Louisville
This option will ask for the local laboratory name that equates to the
Reference NOIS:
==============
NA
a
ASSOCIATED E3Rs:
===============
NA
ASSOCIATED REMEDY TICKETS:
following seven common test names
=========================
NA
ROUTINE SUMMARY:
================
The following routines are included in this patch. The second line
of each of these routines now looks like:
<tab> ;;5.01;MENTAL HEALTH;**[patch list]**;Dec 30,1994
to 7 days. Renewals and refills were not allowed. In addition, the
Checksum Values
Routine Name Before Patch After Patch Patch List
------------ ------------ ----------- ----------
YSCLSERV 25083145 25564583 18,22,26,47,
61,69,74,90
YSCLSRV1 1605367 1606233 61,69,74,90
YSCLSRV2 16840829 24723007 69,90
YSCLSRV3 7345805 24872037 74,90
White Blood Cell Count
YSCLTEST 12047382 12378003 18,22,26,47,
61,69,74,90
YSCLTST1 15450428 11839450 18,22,25,26,
47,61,69,74,90
YSCLTST2 11178871 32098862 18,22,26,47
61,69,74,90
YSCLTST3 15031797 25645207 18,22,25,26
47,61,69,74,90
Absolute Neutrophil Count
List of preceding patches: 18,22,25,26,47,61,69,74
Sites should use CHECK^XTSUMBLD to verify checksums.
Installation Instructions:
==========================
NOTE: This KIDS install does not place any options out of service
during the install and no existing user options are affected.
The site should answer "NO" to all three questions.
Neutrophil %
Note: You may not receive all three prompts at your site.
"Want KIDS to Rebuild Menu Trees Upon Completion of
Install? YES// NO"
"Want KIDS to INHIBIT LOGONs during the install? YES// NO"
"Want to DISABLE Scheduled Options, Menu Options, and
Protocols?
YES// NO"
Segs (Percent)
1. Use the 'INSTALL/CHECK MESSAGE' option on the PackMan menu.
This option will load the KIDS package in this message onto
your system.
2. The patch has now been loaded into a Transport global on
your system. You now need to use KIDS to install the
Transport global.
On the KIDS menu, under the 'Installation' menu, use the
Bands (Percent)
following options:
Print Transport Global
Compare Transport Global to Current System
Verify Checksums in Transport Global
Backup a Transport Global
3. Users may remain on the system, installation may be done at
any time except during the time scheduled for the Clozapine
roll-up.
Segs (Absolute Count)
4. No options need to be placed out of service.
5. Installation time is less than 2 minutes during off peak
hours and less than 5 minutes during peak hours.
6. Installation of this patch requires no additional memory
space.
7. From the 'Installation Menu' of the KIDS menu, run the
option:
Bands (Absolute Count)
'Install Package(s)' Select the package 'YS*5.01*90 and
proceed with the install.
You will also be asked to fill in the reporting format for each test.
Clozapine reporting software automatically discontinued any patient if
Most sites report WBC and Neutrophil results in K/unit format (K/cc or
K/cu mm or K/mm-3 or K/mL). For example, WBC equals 5.1. However, some
report results as discrete units. For example, WBC equals 5100. This
field will allow the site to specify how results are reported. Entries
that report in a percentage (such as Neutrophil %, Segs %, and Bands %)
should use "Percentage".
You may input as many names from the local laboratory definition for each
of these tests as needed. Remember that the laboratory may have designed
special names for specific test equipment, specific test locations, or
the patient's prescription was over 28 days old. This was to prevent a
specific test conditions, such as manual counts.
In fact, if your facility has Clozapine patients with blood samples drawn
and tested on a fee-basis at other CLIA (Clinical Laboratory Improvement
Amendments) approved labs, it is extremely important for your Laboratory
have tests to accept manual input of these tests.
Therefore, you should involve laboratory managers or ADPAC (Automated
Data Processing Application Coordinator) in selection of these names -
both to define the test names currently in use and to create the
patient from being issued medication on an expired prescription. The
provision for manual entry of data. Please be certain every possible
local laboratory name that represents these tests is entered that relates
to each of the seven test names above. Pharmacy dispense will be
prevented unless the program can find the needed test results under one
of names you identify as an equivalent for each of the seven tests.
Security Key: The YSCL AUTHORIZED Security Key is new with this patch.
This key must be assigned to each provider authorized to dispense
Clozapine.
revised Clozapine protocol allows for a monthly prescription as well as
EXAMPLE: CLOZAPINE MULTI TEST LINK [Link Multiple Tests to Clozapine]
option
Select OPTION NAME: CLOZ
1 CLOZAPINE MULTI TEST LINK Link Multiple Tests to Clozapine
2 CLOZAPINE DATA SERVER YSCLSERVER Clozapine Data Server
3 CLOZAPINE PHARMACY MANAGER PSOL MANAGER Clozapine Pharmacy
Manager
4 CLOZAPINE TEST LINK YSCL TEST LINK Clozapine Test Link
CHOOSE 1-4: 1 CLOZAPINE MULTI TEST LINK Link Multiple Tests to
weekly and bi-weekly. The patient is now automatically discontinued if
Clozapine
Link Multiple Tests to Clozapine
Currently linked Tests:
NEUTROPHIL MATURITY, MEAN represents WHITE BLOOD COUNT
SEGS represents BANDS %
Enter the name of the test for Clozapine: WBC WBC
Enter the type of the test for Clozapine: ?
Enter a code from the list.
the issue date for the most recent prescription is greater than 56 days
Select one of the following:
W WHITE BLOOD COUNT
A ABSOLUTE NEUTROPHIL COUNT
N NEUTROPHIL PERCENT
S SEGS %
B BANDS %
T BANDS ABSOLUTE
C SEGS ABSOLUTE
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