Impact of active monitoring on lithium management in Norfolk

Abstract

Background: Lithium has been used in the fields of rheumatology and psychiatry since the 1800s and it is now generally considered to be a gold standard treatment for bipolar disorders. However, lithium is known to have significant side effects and requires close serum level monitoring to ensure levels remain within the therapeutic range to minimize the risk of serious adverse effects or toxicity. This article reviews the monitoring of lithium and reports on the implementation of a regional lithium register and database within Norfolk. Methods: Recorded blood results from the Norfolk lithium database were extracted for the first full year of operation across the region, 2005/6, and from the most recent full year 2011/12. The number of lithium monitoring tests, U&Es and thyroid function tests conducted on all people registered on the database were compared between the two sample years. Results: In 2005/6 there were a significant number of people not receiving the recommended number of four or more serum lithium test per year (68.3%) and the majority of people had two or three tests (62%). By 2011/12 this had noticeably increased with the majority of patients having four or more tests per year (68.5%) and the number having only two or three tests reducing dramatically (26.4%). Conclusion: Improved rates of lithium testing and monitoring have been demonstrated since the introduction of the Norfolk database helping to achieve national targets. Consequently, the chances of adverse events from insufficient monitoring have been minimized

Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting

“…For renal and thyroid tests, 73% and 60% of patients, respectively, were tested at the recommended frequency of 6 months or more often. In comparison with the most recent audits, the monitoring performance is very similar to the post-QIP POMH audit (Paton et al, 2013) and poorer than in the Norfolk audit (following the implementation of a regional lithium register and database) (Kirkham et al, 2013). Among the sub-groups at an increased risk of toxicity, there were too few patients over the age of 65 or with a chronic co-morbidity to draw meaningful conclusions.…”

“…similar to the clozapine system). Similar strategies have previously been attempted in smaller settings (Eagles et al, 2000;Kirkham et al, 2013) and have been shown to reduce the discrepancies between guideline recommendation and clinical practice (Aubry et al, 2017).…”

Monitoring of patients treated with lithium for bipolar disorder: an international survey

“…Adequate monitoring of patients during lithium use is needed for early identification of patients with (potential) ADEs and for optimal dosing (Kirkham et al 2013 ; Severus et al 2008 ; Aral and Vecchio-Sadus 2008 ; Baird-Gunning et al 2017 ). So far, it is not known how different health care professionals internationally aim to achieve safe and effective lithium treatment through monitoring.…”

One lithium level >1.0 mmol/L causes an acute decline in eGFR: findings from a retrospective analysis of a monitoring database

“…Following the introduction of the database the rates of lithium testing and monitoring have improved, helping the county to achieve national standards for the past 10 years with no known cases of toxicity due to inadequate monitoring. 8 Owing to the size of the cohort of patients on the database it is hoped that this analysis, as part of ongoing research, will establish the quantitative effect of different lithium levels on glomerular renal function expanding on work carried out by Rej et al, 9 Aiff et al 10 and Bendz et al 11 Aim and objective The aim and objective of this analysis was to establish the effects on eGFR at ≤3 months, 6 months (±3 months) and 1 year (±3 months) follow-up post exposure to a single lithium level within specified ranges, when patients are monitored in line with current UK recommendations for three monthly lithium level tests.…”

“…Following the introduction of the database the rates of lithium testing and monitoring have improved, helping the county to achieve national standards for the past 10 years with no known cases of toxicity due to inadequate monitoring. 8 Owing to the size of the cohort of patients on the database it is hoped that this analysis, as part of ongoing research, will establish the quantitative effect of different lithium levels on glomerular renal function expanding on work carried out by Rej et al , 9 Aiff et al 10 and Bendz et al . 11 …”