Improving Compliance with Lithium Monitoring Guidelines through a Nurse-Led Clinic: A Full Clinical Audit Cycle
M. Ali, N. Quigley, D. DolanIntroduction
Lithium is a widely prescribed mood stabilizer for bipolar disorder, requiring regular monitoring due to its narrow therapeutic index and potential for thyroid and renal dysfunction. NICE guidelines recommend 6-monthly thyroid function tests (TFTs) and Urea and Electrolytes (U&E’s), documented therapeutic lithium levels, clinical review of results, and structured follow-up. A local review of adult community mental health services in an urban setting identified inconsistent compliance with these standards.
Objectives
To assess compliance with NICE guidelines on lithium monitoring, introduce a nurse-led intervention, and re-audit to evaluate its outcome.
Methods
This full clinical audit cycle involved 14 patients on lithium under the care of a general adult community mental health service. A spreadsheet was developed to record all the data and was then analyzed.
Intervention: In January 2025, a nurse-led lithium monitoring clinic was launched, offering structured appointments, reminders, GP collaboration, and systematic documentation. Psychoeducation was provided to the team on the results after completion of cycle one.
Results
Cycle 1 fell short across all guideline standards, with deviations ranging from 21% to 36%. After the nurse-led intervention, Cycle 2 showed marked improvement, with all parameters reaching over 85% compliance. The largest improvement was in the documentation and clinical sign-off of investigations (+29.2%), demonstrating the benefit of structured, clinician-led oversight.
Image 1: Long description.