Lithium Support Tool
Lithium Support Tool
NHS Care Services
High Risk Medicine Initiative
Lithium Support Tool Notes - What is Lithium?
Lithium is used to:
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prevent mood swings caused by ‘bipolar affective disorder’ – this is also known as ‘manic depression’, or sometimes just ‘bipolar’
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treat mania – feeling very excited and being over-active;
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treat depression – in people who have had depression that has been very severe, lasted a long time, or keeps coming back. For these people, lithium can help to keep their mood stable.
What are the risks?
The National Patient Safety Agency (NPSA) received 567 incident reports (October 2003 to December 2008) relating to lithium use. Two reports were of severe harm, 34 moderate and 531 low or no harm. The most common error was ‘wrong or unclear dose or strength’ (124 incidents). The NHS Litigation Authority dealt with two fatal and 12 severe harm incidents1 involving lithium therapy and the Medical Defence Union has been involved with 15 incidents directly related to lithium toxicity and monitoring.
An audit found that only 42 per cent of patients on initiation of lithium therapy were documented to have been informed of risk factors for toxicity. For patients maintained on lithium therapy in the previous year, the audit found:
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one in 10 patients had no documented lithium blood level. (National Institute for Health and Clinical Excellence (NICE) standard: one blood level
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one in five patients had no renal function tests documented (NICE standard: assessment every six months. Not met for 46 per cent of patients);
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one in six patients had no thyroid function tests documented (NICE standard: assessment every six months. Not met for 51 per cent of patients).
NPSA Safe Prescribing and Dispensing Guidance
Not all of this guidance is relevant to pharmacists but should be considered where appropriate:
| Lithium |
Patients prescribed lithium are monitored in accordance with NICE guidance;
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| There are reliable systems to ensure blood test results are communicated between laboratories and prescribers |
| At the start of lithium therapy and throughout their treatment patients receive appropriate ongoing verbal and written information and a record book to track lithium blood levels and relevant clinical tests. |
| Prescribers and pharmacists check that blood tests are monitored regularly and that it is safe to issue a repeat prescription and/or dispense the prescribed lithium |
| Systems are in place to identify and deal with medicines that might adversely interact with lithium therapy |
While many medications have been reported as interacting with lithium, (see Stockley ) this monitoring must highlight as a minimum the potential for lithium’s interactions with the following commonly prescribed therapies and OTC medicines:
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Chronic Medication Service and Lithium risk assessment support tool
As part of CMS progression it has been agreed that support will be given in the first instance to two high risk medicines. One of these medicines is Lithium. To fulfil the requirements of the NPSA patient safety bulletin the following support tool has been integrated into PCR for completion with the patient.
Further information has been prepared by the Scottish Government to support pharmacists in delivering support to patients.
Community Pharmacy Scotland has sent every member in Scotland labels to support identification of completed dispensings for Lithium. This will make sure patients are easily identified for intervention when prescriptions are supplied to the patient.
An example of the Lithium label is below.
