Lithium Audit

Contents

• Lithium Monitoring

• The Lithium Audit

• Table 1.1 - Comparison of Data
  

Lithium Monitoring

Lithium is a long established and effective treatment option for certain forms of major mental illness in particularly affective disorders.  Treatment is generally initiated by Psychiatric specialists and often continues for many years, however many patients are followed up on a shared care basis or solely in General Practice.

To be safe and effective, treatment should be monitored regularly by clinical   review and blood monitoring (including serum lithium levels, thyroid function and renal function tests).  Such monitoring is dependant on appropriate follow up and good communication between health care professionals (especially in shared care) and with patients.   Monitoring is particularly important as lithium has a narrow therapeutic index. Low lithium levels can result in poor symptom control.   High levels with the risk of lithium toxicity, which can be a serious medical emergency with risk of permanent neurological deficit, renal failure and even death.  There is evidence that the monitoring of patients in the NHS is often sub-optimal.  Lithium toxicity is a common reason for medical litigation in psychiatric practice^.  Creating safe and effective systems, which enhance co-operation and communication between health care professionals that result in improved patient monitoring is therefore important.

1997-98 an audit of 17 practices in Leicestershire organised by the PCAG showed that several aspects of current management of Lithium were unsatisfactory.  Following a meeting of interested parties in late 1998, the Interface Audit Group of Leicestershire Health agreed to fund a Lithium Register pilot project.  This was set up by Dr. Falconer Smith, and the project was kept under review by a multi-disciplinary steering group, chaired by Dr. Farooqi.  The pilot Register was launched in January 1999 and monitors lithium, thyroid and renal blood test results. 

An information leaflet about the Leicestershire Central Lithium Register can by downloaded by following this link (pdf file)

Further information can also be obtained by telephoning (0116) 256 3470.    

The Lithium Audit

1997/98 data was collected from 17 practices, which would answer the following criteria.

1.                 Patients who are receiving lithium monitoring must be recorded
in a practice lithium register

2.                 It is explicit in the medical records who is responsible for monitoring the lithium levels of the patient

3.                 The records show that the lithium levels are checked every three months and are in an agreed range.

4.                 T4, TSH are performed at least annually

5.                 Serum Creatinine is performed at least annually

6.                 The records show that patients are issued with a lithium card

7.                 Patients should be reviewed at least six monthly

The principle findings of the first data collection were:

§        Evidence of sub-optimal monitoring

§        Evidence of patients falling between primary care and secondary care

§        Evidence of poor communication of lithium results between primary care and secondary care

A re-audit was undertaken in May 2000 and the results are shown in table 1.1

Table 1.1

In 2001, it was decided to roll out the Lithium Audit to all practices across Leicestershire and Rutland and at the same time inform practice of the Central Lithium Register.  This process took approximately one year with the assistance of a part time member of staff from Secondary Care.  By February 2002, 696 data collection forms were returned from 85 practices.  The results have been collated and produced in a report, which is currently on it’s final draft and will be placed on this website when completed.