Developing a New Lithium Policy

AIMS: The psychiatry liaison team at Chelsea and Westminster Hospital (C&W) specialises in working together with different healthcare teams to improve patient outcomes. Following feedback received from ward teams who manage the patients that we support on a daily basis, we identified a need for an accessible and user-friendly document that could give some guidance towards safely managing patients on lithium, including lithium toxicity. We do not anticipate medical teams at C&W to initiate lithium therapy without liaison psychiatry input. The most likely scenario where staff will encounter lithium is in patients admitted whilst on established lithium therapy. The aim of the guidance document is to support our medical and surgical colleagues across the hospital site to safely continue to prescribe lithium. METHODS: To create this document, we reviewed joint Lithium Policies across several NHS Trusts in England. This policy has been adapted from Central and North West London's own policy to be more specific in supporting best practice for clinicians in initiating, monitoring and adjusting lithium therapy in a safe and timely way. Junior doctors in liaison psychiatry wrote policy which was re-drafted with consultant support and input. Additionally, specialist advice was provided by mental health pharmacists for subsequent revisions. At present, the policy is awaiting discussion at a prescribing group meeting prior to starting the implementation process across the trust. RESULTS: Multidisciplinary feedback from pharmacy has advised that this guidance is particularly useful because lithium patients are so infrequent (approximately 55 patients on lithium at C&W in a 12 month period). Ward teams are therefore unfamiliar with prescribing and managing lithium, and crucially, at recognising signs and symptoms of toxicity. The guidance is not only functional, but is incredibly accessible. It is well laid out and makes use of colour to make it user-friendly. It is an appropriate length and includes a one page overview that is ideal for printing or for quick-reference. CONCLUSION: Developing this lithium policy has been a key patient safety project. We hope this document will be a useful and safe tool for ward teams to refer to. Liaison psychiatry continue to have an excellent relationship with our ward colleagues and we hope this policy represents our ongoing dedication towards service development. During this process, we have been grateful for the expert help from our pharmacy colleagues and have learnt about how liaison psychiatry can support ward teams by creating a robust and easy to follow guideline.