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standards of lithium monitoring in mental health trusts in the uk标准的锂监测在心理健康信托在英国
Collins et al. BMC Psychiatry 2010, 10:80
/1471-244X/10/80
RESEARCH ARTICLE Open Access
Standards of lithium monitoring in mental health
trusts in the UK
1,2 2,3 2 4 2,3*
Noel Collins , Thomas RE Barnes , Amber Shingleton-Smith , David Gerrett , Carol Paton
Abstract
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
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