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(If the earliest prescription for lithium is after 1st January 2009, they will not be counted in the denominator population for this indicator)
d6...%
665B. Lithium stopped (recorded after last prescription issued)
Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential toxicity from intercurrent illness, declining renal function or co-prescription of drugs e.g. thiazide diuretics or NSAIDs which may reduce lithium excretion. However, there is no definitive evidence on the frequency of lithium level checks. Most practitioners would monitor lithium levels when stable every three to six months. Where a practice is prescribing, it has responsibility for checking that routine blood tests have been done (not necessarily by the practice) and for following up patients who default where responsibility has been accepted for administering treatment.
The therapeutic range for patients on lithium therapy is normally 0.4 -1.0mmol/l (see the British National Formulary). If the range differs locally, the PCO will be required to allow for this.
Practices should report the percentage of patients on lithium whose last serum lithium level is in the therapeutic range. The level should have been undertaken in the previous six months.
In verifying that this information has been correctly recorded, a number of approaches could be taken by a PCO:
i. Inspection of the output from a computer search that has been used to provide information on this indicator.
ii. Inspection of a sample of records of patients on lithium therapy to look at the proportion with recorded serum lithium in the therapeutic range.
iii. Inspection of a sample of records of patients on lithium therapy for whom a record of serum lithium in the therapeutic range is claimed, to see if there is evidence of this in the medical records.
Prepared By Jean Keenan