title: Impact of active monitoring on lithium management in Norfolk.
abstract: BACKGROUND
  Lithium has been used in the fields of rheumatology and psychiatry since the 1800s and it is now generally considered to be a gold standard treatment for bipolar disorders. However, lithium is known to have significant side effects and requires close serum level monitoring to ensure levels remain within the therapeutic range to minimize the risk of serious adverse effects or toxicity. This article reviews the monitoring of lithium and reports on the implementation of a regional lithium register and database within Norfolk.
  
  
  METHODS
  Recorded blood results from the Norfolk lithium database were extracted for the first full year of operation across the region, 2005/6, and from the most recent full year 2011/12. The number of lithium monitoring tests, U&Es and thyroid function tests conducted on all people registered on the database were compared between the two sample years.
  
  
  RESULTS
  In 2005/6 there were a significant number of people not receiving the recommended number of four or more serum lithium test per year (68.3%) and the majority of people had two or three tests (62%). By 2011/12 this had noticeably increased with the majority of patients having four or more tests per year (68.5%) and the number having only two or three tests reducing dramatically (26.4%).
  
  
  CONCLUSIONS
  Improved rates of lithium testing and monitoring have been demonstrated since the introduction of the Norfolk database helping to achieve national targets. Consequently, the chances of adverse events from insufficient monitoring have been minimized.
authors.affiliation: School of Pharmacy, University of East Anglia, Norwich Research Park, Norfolk NR4 7TJ, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirkham
authors.forename: Stephen
authors.initials: S
authors.lastname: Bazire
authors.forename: Timothy
authors.initials: T
authors.lastname: Anderson
authors.forename: John
authors.initials: J
authors.lastname: Wood
authors.forename: Paul
authors.initials: P
authors.lastname: Grassby
authors.forename: James A
authors.initials: JA
authors.lastname: Desborough
keywords: bipolar disorder; databases; drug monitoring; factual; lithium; psychiatry