| Title: |
Standards of lithium monitoring in mental health trusts in the UK |
| Authors: |
Collins, N; Barnes, TRE; Shingleton-Smith, A; Gerrett, D; Paton, C |
| Publisher Information: |
BioMed Central |
| Publication Year: |
2010 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
Science & Technology; Life Sciences & Biomedicine; Psychiatry; SCI; GUIDELINES; OVER-65S; DISORDER; QUALITY; Benchmarking; Bipolar Disorder; Commission on Professional and Hospital Activities; Drug Monitoring; Drug Prescriptions; Drug-Related Side Effects and Adverse Reactions; Electronic Prescribing; Humans; Kidney Function Tests; Lithium Compounds; Practice Guidelines as Topic; Practice Patterns; Physicians'; Safety Management; Surveys and Questionnaires; Thyroid Function Tests; United Kingdom; Drug Toxicity; Questionnaires; Physician's Practice Patterns; Great Britain; 1103 Clinical Sciences |
| Description: |
Background Lithium is a commonly prescribed drug with a narrow therapeutic index, and recognised adverse effects on the kidneys and thyroid. Clinical guidelines for the management of bipolar affective disorder published by The National Institute for Health and Clinical Excellence (NICE) recommend checks of renal and thyroid function before lithium is prescribed. They further recommend that all patients who are prescribed lithium should have their renal and thyroid function checked every six months, and their serum lithium checked every three months. Adherence to these recommendations has not been subject to national UK audit. Methods The Prescribing Observatory for Mental Health (POMH-UK) invited all National Health Service Mental Health Trusts in the UK to participate in a benchmarking audit of lithium monitoring against recommended standards. Data were collected retrospectively from clinical records and submitted electronically. Results 436 clinical teams from 38 Trusts submitted data for 3,373 patients. In patients recently starting lithium, there was a documented baseline measure of renal or thyroid function in 84% and 82% respectively. For patients prescribed lithium for a year or more, the NICE standards for monitoring lithium serum levels, and renal and thyroid function were met in 30%, 55% and 50% of cases respectively. Conclusions The quality of lithium monitoring in patients who are in contact with mental health services falls short of recognised standards and targets. Findings from this audit, along with reports of harm received by the National Patient Safety Agency, prompted a Patient Safety Alert mandating primary care, mental health and acute Trusts, and laboratory staff to work together to ensure systems are in place to support recommended lithium monitoring by December 2010. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
BMC Psychiatry; http://hdl.handle.net/10044/1/43606 |
| DOI: |
10.1186/1471-244X-10-80 |
| Availability: |
http://hdl.handle.net/10044/1/43606; https://doi.org/10.1186/1471-244X-10-80 |
| Rights: |
© 2010 The Authors; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Accession Number: |
edsbas.134B96DF |
| Database: |
BASE |