Abstract
Lithium is the mainstay treatment for the management of treatment-resistant depression and long-standing bipolar affective disorder; Given the narrow therapeutic window and the fact that the elderly is an especially vulnerable population group, the need for monitoring is of particular importance. The purpose of this audit is to evaluate the practice for patients on lithium at an old age psychiatric community team and to compare these results with the 2020’s original audit. To then check for any improvements since the implementation of the last year’s measures and recommend changes. We requested an updated list of patients under lithium in our practice from September to October 2021. We then reviewed the ChiE and RiO notes and confronted these results with the recommended monitoring standards for lithium (NICE). We noticed that there was an improvement of 61,5% in the measurement of the BMI and the calcium (61,5% 2021 as opposed to 33,33% in 2020). However, lithium measurements within the correct time frame have declined (93,3% in 2020 as opposed to 76,9% in 2021), as well as urea and electrolytes monitoring that dropped more than 30%. The thyroid function tests have fallen from 86,6% in 2020 to 61,5% in 2021. Observed toxicity symptoms and side effects, as well as its discussion with the patients, weren’t always explicitly recorded in the notes. To conclude, although there have been some developments in comparison to 2020, the team’s lithium monitoring is still below the standards set by the NICE guidance. Recommendations were made, such as implementing a central database of patients taking lithium and due dates for the next monitoring on the team’s shared drive, for the proforma to be added and filled in on the system and if the expected normal lithium’s range for each patient was documented.