Dear member,

The QPS Lithium Audit must be undertaken over a consecutive 3 month period therefore it is important for you to start the audit NOW!

The very last date for starting the audit is 29^th November 2019 (but DO NOT leave it until this date)

The aim of this audit is to reduce harm associated with lithium. This will be achieved by improving lithium monitoring and patient understanding through a focus upon auditing patient medication records, engagement of patients and referral to general practice or the prescriber, as appropriate.

What you need to do:

1. Check if you have had any patients dispensed lithium in the preceding 3 month period – IF YES, you may continue with the lithium audit
2. Read the following Documents: NPSA Alert Safer Lithium Therapy & NICE Guidance Bipolar Disorder: assessment and management
3. If NO - Your audit must be done on one of the following medicines – Methotrexate, Amiodarone or Phenobarbital (See Templates Attached)
4. Audit must be done over a 3 month period but each patient is only to be recorded once
5. If a patient has not collected themselves you must attempt to contact the patient by other means e.g. telephone if unreachable then record this on the patients PMR
6. Ask patients to bring their lithium record book every time they collect their prescription (But do not refuse to supply their medication if they do not have it)
7. Follow the questions in the audit sheet & keep a record on the patients PMR
8. Keep audit records for 2 years

You should also discuss the following with your patients:

• Can patients describe to you:
  • Signs of lithium toxicity – e.g. upset stomach
  • How to prevent toxicity – e.g. Adequate fluid intake especially if exercising heavily
  • What to do if they miss one or more doses
• If they cannot describe the information above it is important gaps in knowledge are filled
• Dehydration and electrolyte imbalance can lead to lithium toxicity. It is essential to provide advice on maintaining adequate fluid intake during exercise, particularly if a patient increases the level of exercise following advice.
• Provide advice relating to safe alcohol consumption for the same reasons.
• Weight gain is a potential side-effect of lithium and patients should be provided with advice on maintaining a healthy diet
• An assessment of the patient’s understanding of the need to seek professional advice before taking non-prescribed medicines, e.g. over the counter (OTC), including herbal remedies or supplements, should take place.
• The pharmacy team should ensure the patient/carer fully understands the importance of this

For any further help and support please contact the PharmaPlus team.

Regards,

PharmaPlus