Safe lithium use in a non-psychiatric versus a psychiatric inpatient veterans affairs hospital setting: a retrospective assessment.
OBJECTIVE
This study examined practices for monitoring lithium in a non-psychiatric versus psychiatric inpatient setting at a Veterans Affairs facility.


METHODS
This retrospective chart review included veterans who had an active order of lithium during their non-psychiatric or psychiatric inpatient stay over the time period of January 2000 to September 2011. Chi-square tests were used for data analysis. Frequency of appropriate lithium monitoring was assessed using standards set by the National Institute for Clinical Excellence and British Association for Psychopharmacology guidelines for bipolar disorder.


RESULTS
A total of 200 patients (100 for each group) were included in the final analysis. Psychiatric inpatients had more frequent serum lithium levels measured during inpatient stay (p = 0.0002), whereas nonpsychiatric patients had more frequent renal monitoring (p = 0.0001). Non-psychiatric patients were significantly more likely to have action taken upon abnormal safety assessments (p = 0.0075).


CONCLUSIONS
Our results demonstrate significant differences between the non-psychiatric and psychiatric inpatient settings in respect to monitoring lithium. The frequency of serum lithium level monitoring in both groups was below the level set by both the National Institute for Clinical Excellence and British Association for Psychopharmacology guidelines. Additionally, frequency of corrective measures in both settings was low, indicating a need for improvement in this area.
Pharmacy Service, Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX 76504.
Mina
M
Mehvar
Pharmacy Service, Central Texas Veterans Health Care System, 1901 Veterans Memorial Drive, Temple, TX 76504.
Jennifer L
JL
Defilippi
D000328:Adult; D004347:Drug Interactions; D016903:Drug Monitoring / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006778:Hospitals, Psychiatric / Q000592:standards*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D007677:Kidney Function Tests; D008094:Lithium / Q000097:blood; D018020:Lithium Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014728:Veterans / Q000523:psychology
D018020:Lithium Compounds; D008094:Lithium