Abstract
This study examined practices for monitoring lithium in a non-psychiatric versus psychiatric inpatient setting at a Veterans Affairs facility. 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. 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). 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.
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