Citation

Chakraborty A, Yilanli M, Stromberg N. J. Indian Med. Assoc. 2020; 118(11): 44-47.

Copyright

(Copyright © 2020, Indian Medical Association)

DOI

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PMID

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Abstract

BACKGROUND: Lithium has established efficacy in the treatment of bipolar affective disorder and is one of the few medications known to reduce the risk of suicide. Due to its narrow therapeutic index, drug levels are needed to monitor for toxicity. Long term lithium treatment increases risk of hypothyroidism, hyperparathyroidism and progressive renal insufficiency. As per VA/DoD clinical practice guidelines for management and treatment of bipolar disorder, maintenance therapy requires serum lithium monitoring every 6 months as well as annual Creatinines, TSH and CBCs with differential counts. Aims:To develop a program to improve the blood monitoring of patients who are on lithium to 75% over an 8-month period at the VA Hospital in Detroit.

METHODS: A retrospective audit was conducted in August 2016 of blood monitoring for all patients who were taking lithium at the VA hospital in Detroit and compared it to published guidelines. We then implemented a series of educational programs and reminders to improve the adherence rate. A re-audit was completed in March 2017.

RESULTS: A significant improvement in all suggested monitoring was observed after the reminders and informative educational materials had been delivered. Serum lithium monitoring went up by 28% and overall maintenance monitoring standards went up by 31%.

CONCLUSIONS: We were able to demonstrate improvement in the level of adherence in all of the Guideline recommended monitoring parameters at one VA Hospital with the use of educational material and reminders. This program may be practical for dissemination to other hospitals. © 2020 Indian Medical Association. All rights reserved.

Language: en

Keywords

Lithium; Bipolar Disorder; Quality Improvement