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SO066

Compliance with monitoring for lithium-associated neurotoxicity in psychiatric inpatients: a retrospective audit

COMPLIANCE WITH LITHIUM-ASSOCIATED NEUROTOXICITY MONITORING IN PSYCHIATRIC INPATIENTS: A RETROSPECTIVE AUDIT

Assessment for neurotoxicity on admission was documented in only 61.5% of inpatients taking lithium, while lithium level measurement had the lowest compliance among the monitoring measures (23.1%).

The aim of the audit was to assess compliance with documentation of neurological monitoring for lithium toxicity in psychiatric inpatients prescribed lithium; secondary aims were to measure compliance with biochemical monitoring and identify gaps to inform targeted quality improvement initiatives. The poster emphasises that lithium has a narrow therapeutic index, that neurotoxicity can occur even at therapeutic serum levels, and that its manifestations may include confusion, tremor, ataxia and seizures. The study was a retrospective clinical audit of electronic health records over a twelve-month period in adult psychiatric inpatient wards within an NHS trust (RDaSH); it included 15 adult admissions, of whom 13 were already taking lithium and 2 started it during admission. The primary criterion was documentation of at least two of the following: confusion, paraesthesia, tremor and ataxia. Secondary criteria were urea and electrolytes and estimated glomerular filtration rate (U&Es/eGFR) and thyroid function tests (TFTs) within 24 hours, and a lithium level within 72 hours when clinically indicated. The audit target was 100% compliance, and the data were analysed descriptively. Neurological monitoring was documented in 8 of the 13 eligible admissions (61.5%) and was not documented in 5 (38.5%); lithium levels were measured within 72 hours in only 3 of 13 patients (23.1%), while renal function tests were performed within 24 hours in 9 of 15 patients (60.0%) and thyroid function tests in 6 (40.0%). The conference abstract additionally reports that liver function tests were completed in 11 of 15 patients (73.3%), making this the measure with the highest compliance. Renal monitoring was found to be more reliable than thyroid monitoring, although timely U&Es/eGFR testing was not performed in 40% of admissions. In conclusion, neurological monitoring on admission was inconsistently documented, biochemical monitoring varied, and there was marked non-compliance with lithium level measurement. To improve practice, the poster recommends monthly multidisciplinary educational meetings and a standardised blood monitoring checklist embedded in the admission workflow. It identifies the small sample (n=15) and retrospective record-based review as limitations and outlines plans for a repeat audit following the intervention.

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