Setting

This audit is relevant to all psychiatrists prescribing lithium to out-patients.

Background

Lithium has an important place in the management of affective disorders but regular monitoring of blood and physical health is important to ensure its safe use. This monitoring is often done in a ‘shared care’ approach between the patient's psychiatrist and general practitioner. One downside of this is the potential for a breakdown in the effective monitoring of therapy.

Standards

The standards were obtained from a guideline on bipolar disorder produced by the National Institute for Health and Clinical Excellence (NICE) (2006). The relevant parts of this guideline include the following:

ᐅ the lithium level should be checked every 3 months

ᐅ urea and electrolytes and thyroid function should be checked every 6 months

ᐅ urea and electrolytes should be checked more often than every 6 months if the patient is taking angiotensin-converting enzyme (ACE) inhibitors, diuretics or non-steroidal anti-inflammatory drugs (NSAIDs)

ᐅ glucose and blood pressure should be checked annually

ᐅ lipids should be checked annually for patients aged over 40 years.

Method

Data collection

The computerised patient record system in a local general practice was used to identify all patients who were prescribed lithium from this practice and from sister practices. This system was used to collect data on:

ᐅ patient age

ᐅ diagnosis

ᐅ drug history

ᐅ date and results for:

Data analysis

The main outcome measure was the percentage of patients taking lithium who had had adequate monitoring of blood pressure, lithium level, thyroid function, urea and electrolytes, glucose and lipids.

Resources required

People

Only one person is required to conduct this audit, but if that person is unfamiliar with the computerised system the practice uses, help from a staff member at the practice may be needed.

Time

This will depend on the size of the practice, but it is estimated that all information could be obtained from the practice computer system in around 8 hours.