Minimizing negative outcomes associated with potentially harmful lithium levels by means of pharmacist-led educational interventions in an inpatient psychiatric facility

Comparison of pharmacist- and provider-managed lithium in an inpatient medical center: A 6-month review

BACKGROUND

Lithium is commonly used for the treatment of mood disorders and possesses a narrow therapeutic index. A medication utilization evaluation performed regarding its use at an academic medical center found that only 89.9% of patients received a lithium level within 24 hours of admission. This review prompted development of the evaluated protocol.

OBJECTIVE

To compare pharmacist- and provider-managed safety and biochemical monitoring outcomes in a medical and psychiatric hospital population.

METHODS

A retrospective chart review was conducted to identify hospitalized medical or psychiatric patients who received lithium therapy during a 6-month period. Patients were excluded if younger than 16 years or if lithium therapy was ordered but never administered. For cohort comparisons, descriptive statistics were used for baseline characteristics, and chi-square test or t test was used for outcomes.

RESULTS

Pharmacists managed 67 patients versus 63 provider-managed patients. Pharmacist-managed patients were more likely to receive a lithium level within 24 hours of admission (100% vs. 89.1%, P = 0.012); receive a pregnancy test if indicated (90.5% vs. 41.7%, P < 0.001); have an identified drug interaction affecting lithium levels (47.8% vs. 27%, P = 0.014); and receive pharmacy-provided education (71.6% vs. 34.9%, P < 0.001).

CONCLUSION

Patients initiated or maintained on lithium therapy require a unique level of management within the inpatient realm. The addition of lithium management to existing pharmacy services creates the opportunity to deliver safer and more complete patient care while expanding practice offerings for clinical pharmacists.

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders

INTRODUCTION

Psychiatric and neurologic illnesses are highly prevalent and are often suboptimally treated. A 2015 review highlighted the value of psychiatric pharmacists in improving medication-related outcomes. There is a need to describe areas of expansion and strengthened evidence regarding pharmacist practice and patient care impact in psychiatric and neurologic settings since 2015.

METHODS

A systematic search of literature published from January 2014 to June 2019 was conducted. Publications describing patient-level outcome results associated with pharmacist provision of care in a psychiatric/neurologic setting and/or in relation to central nervous system (CNS) medications were included.

RESULTS

A total of 64 publications were included. There was significant heterogeneity of published study methods and data, prohibiting meta-analysis. Pharmacists practicing across a wide variety of health care settings with focus on CNS medication management significantly improved patient-level outcomes, such as medication adherence, disease control, and avoidance of hospitalization. The most common practice approach associated with significant improvement in patient-level outcomes was incorporation of psychiatric pharmacist input into the interprofessional health care team.

DISCUSSION

Pharmacists who focus on psychiatric and neurologic disease improve outcomes for patients with these conditions. This is important in the current health care environment as most patients with psychiatric or neurologic conditions continue to have unmet needs. Additional studies designed to measure pharmacists' impact on patient-level outcomes are encouraged to strengthen these findings.

Outcomes of patient education practices to optimize the safe use of lithium: A literature review

INTRODUCTION

Lithium is commonly used to treat various psychiatric disorders and is particularly effective in the maintenance phase of bipolar disorder. Unfortunately, this drug has a narrow therapeutic index and, if not monitored regularly, can result in toxicity. Therefore, for lithium to be prescribed safely, clinicians must ensure that patients are well educated on lithium toxicity, its prevention, and symptom recognition. This article summarizes studies that investigated lithium education strategies to help promote the safe use of lithium.

METHODS

Four electronic databases were searched using key terms and subject headings. Reference lists of relevant papers were also reviewed. The search was limited to literature published in English, without year limits. Eligible studies examined lithium patient education and the impact on patients' knowledge of safe lithium use.

RESULTS

Of a total of 517 citations that were retrieved from the electronic database search, 12 were selected for inclusion in this review. Most of the studies included assessed the effect of lithium education on various aspects of patients' knowledge, including but not limited to, lithium toxicity. Of the studies assessing the correlation between lithium knowledge and lithium levels, most demonstrated a positive correlation between lithium knowledge and lithium levels that were more stable and within the higher end of the recommended therapeutic range.

CONCLUSIONS

Studies evaluating lithium patient education and its effect on improving the safe use of lithium are limited. Nevertheless, this literature review highlights that lithium patient education is critical to promote its safe use.