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Safe Prescribing of Lithium

The following CDRC resources are available to support safe Lithium Prescribing.

Set-up

The CDRC Lithium monitoring system automatically detects patients with lithium on the repeat medication list who are being issued with lithium. If your unit wishes to leave Lithium off repeat prescription lists (not advised) you can use a specific Lithium recall to flag patients requiring lithium monitoring. You will need to add the recall type: Setup > Data Entry > Recall type 

Amend Recall Type Recall type name Shon name Category Lithium Shared Care Applicable genders Minimum applicable age Maximum applicable age Defaut recall period Recall deadline Follow-up recall type Females years years No Deadline Z] Prompt before creating follow-up Follow-up date is relative to last recall date Template Availabilty C] Cytology smear dialog (for wating for resuts) C] Cytology resut dialogs (for scheduling next smear) Vaccination dialog C] Contraception dialog Linked Read codes Code - Description No codes selected canc4

For each relevant patient, add the Lithium Shared Care recall, ideally with a date very far into the future so the recall doesn’t clog the home screen. This recall is not set to the recall date, it is just used to allow the system to search for patients on shared care. It is not needed if you are issuing repeat lithium scripts. 

Reports

The following reports, in the CDRC Quality > Drugs Requiring Monitoring folder, identify patients taking lithium who require assessment 

The following reports identify patients taking lithium who require assessment 

Patients will be included in the CDRC Lithium monitoring system (and these reports) if: 

  • They have lithium on their repeat prescription and it has been issued in the last three months 

OR 

  • A current pending recall exists with the exact name Lithium Shared Care 

Patients appear in these results at the following points 

 Usual Test Frequency  
 Three monthly Six monthly 
Test due 77 days 5 months 
Test overdue 84 days 6 months 
Test significantly overdue 89 days 7 months 

The results from these reports can be used as a stand-alone system for Lithium or as part of the integrated CDRC drugs requiring monitoring system. 

Testing frequency for renal function automatically takes into account the most recent renal function/CKD diagnoses. 

Patient Status Alerts

The following icons are shown for patients who are in the CDRC Lithium monitoring system depending on whether the testing is up to date or not.  Clicking on the icon will open the DRM template where there is a link to the lithium template. 

Lithium Template

How to Access:

In the lower left hand corner use the search bar, type in ‘Lithium – CDRC’ and select the template:

Alternatively, press F12 and search for ‘Lithium – CDRC’, this will open the aforementioned template.

Lithium Template

The Lithium template shows key information about monitoring requirements and recent tests. 

For each test one of three statuses will be displayed: 

  • Testing is within date 
  • Testing is overdue 
  • Monitoring is not taking place at this organisation 

There is a link to the shared care guidelines. 

Important drug interactions will be displayed with particular emphasis on RAS drugs, thiazides and NSAIDs. There is a link to more detailed information about drug interactions. 

There is a section to record a checklist of important information regarding Lithium. 

Lithium Lithium Scripts Lithium Interactions Hi Lithium Monitoring Requirements Test Lithium (12h post dose) U+E* Bone, TFTs Weight * U+E 3 monthly if eGFR -60 period 3 Monthly 6 Monthly h Levels Adverse Effects Detailed Results Last 4 Lithium Results - Testing within date 201g Serum lithium le el E v rx 250) 201g Serum lithium le el E v rx 25g) 28 Aug 201g Serum lithium le el E v rx 250) 28 Aug 201 g Serum lithium level [XE25g) Last 3 eGFR Readings - Testing within date 11 dun 201 g GFR calculated Cockroft-Gault formula WOa58) 11 dun 201g GFR calculated abbreviated MORO rxaK8y) 28 Aug 201g CFR calculated abbreviated MORO oxaK8y) Last 2 Thyroid Tests - Testing within date TEM Lithium Shared Care Guidance Show Lithium Scripts Important Drug Interactions High Lithium Levels / Adverse Effects Lthium Checklist 28 Aug 201g serum TSH level 28 Aug 201g serum TSH level Last Calcium - Testing within date 02 May 201g Serum adjusted calcium concentration xabpk) 02 May 201g Serum calcium le el E v rx 2q3) Last Weight - TESTING OVERDUE 28 Jan 201g ORM Lithium Entered by 05 mmol/L Of mmol/L 47 mLJmin 52 ml-imin/1 73m*2 57 ml-imin/1 73m*2 0 36 miu/L 2f8 mmol/L 2 64 mmol/L 754 Kg (11 st 12 1b) O/E - weight (22A. ) FORBES, Lithium Information Date started Indication Initiating clinician Gareth (Dr) (General Medical Practitioner) Current supervising specialist Date transferred to shared care Target lithium level range Last seen by specialist Patient has PIL and Lithium Card Consent model 01 Jan lg32 Bipolar disorder Dr Jones Dr Smith 01 Jan lgso 0 6-0Æ June 201g Yes MHAJCTO
Lithium Checklist

The Lithium checklist is a space where important questions about Lithium prescribing, responsibility and safety can be recorded. To update the checklist (e.g. if the target range changes), right click on the panel showing the most recent answer and choose Copy Questionnaire then Copy Comments. The old answers will be copied forward and can be updated. 

Click Save Final Version once complete. 

Save for Future Editing Lthium In for mation Save Final Version use Previous Answers Lithium Information Date started 01 Jan lg32 Indication Bipolar disorder C] Depression C] Other Initiating clinician Dr Jones Cancel 5 Current supervising specialist Dr Smith Date transferred to shared care 01 dan lgso Target lithium level range 0 6-08 Last seen by specialist June 201g A safety booklet for patients can be found here but it is better to give out a preprinted pack Patient has PIL and Lithium Card Yes O Consent model Informed consent O O MHAJCTO
Lithium Pop-up Alert

As of October 2019, this popup is only enabled for practices in North Durham.  Please contact CDRC to add your area. 

If any Lithium script is issued when testing is overdue, the following alert will be displayed.  There is a link to the template to show what is missing. 

Question You have issued lithium. Routine testing appears to be overdue. aroceed Anyway Yiew Lthium Template Pause

This alert will not trigger, the first time the Lithium is issued, when instead the following message will be displayed. 

Question This appears to be the first issue of lithium Do you want to complete the lithium checklist?

NB. This alert does not trigger for test patients or patients who are not fully registered patients, such as temporary residents.