Prescribing Observatory for Mental Health, Royal College of Psychiatrists Centre for Quality Improvement, 4th Floor, Standon House, 21 Mansell Street, London E18AA, UK.
BMC Psychiatry. 2010 Oct 12;10:80. doi: 10.1186/1471-244X-10-80.
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.
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.
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.
The quality of lithium monitoring in patients who are in contact with mental health services falls short of recognised standards and targets. Findings from this audit, along with reports of harm received by the National Patient Safety Agency, prompted a Patient Safety Alert mandating primary care, mental health and acute Trusts, and laboratory staff to work together to ensure systems are in place to support recommended lithium monitoring by December 2010.
锂是一种常用的药物，治疗指数较窄，对肾脏和甲状腺有公认的不良反应。国家卫生与临床优化研究所（NICE）发布的双相情感障碍管理临床指南建议在开锂之前检查肾功能和甲状腺功能。他们进一步建议，所有开锂的患者应每六个月检查一次肾功能和甲状腺功能，每三个月检查一次血清锂。这些建议的遵守情况尚未在英国进行全国性审核。
心理健康监测观察站（POMH-UK）邀请英国所有国家卫生服务精神健康信托机构参与锂监测与推荐标准的基准审核。数据从临床记录中回顾性收集，并以电子方式提交。
来自 38 家信托机构的 436 个临床小组为 3373 名患者提交了数据。在最近开始服用锂的患者中，分别有 84%和 82%记录了基线肾功能和甲状腺功能检查。对于服用锂一年或以上的患者，只有 30%、55%和 50%的病例符合监测锂血清水平以及肾功能和甲状腺功能的 NICE 标准。
与精神卫生服务有接触的患者的锂监测质量不符合公认的标准和目标。本次审核的结果以及国家患者安全局收到的伤害报告促使发布了一项患者安全警报，要求初级保健、精神卫生和急症信托机构以及实验室工作人员共同努力，确保到 2010 年 12 月建立支持推荐的锂监测系统。
