Patient information standards- Lithium

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Standards

All new patients for whom lithium treatment is being considered will be given appropriate information to allow them to make an informed choice. Where patients lack capacity or are to receive compulsory treatment via a T2 or T3, information will be provided commensurate to their needs and capability.

At regular intervals (minimum annually) throughout lithium treatment, patients information needs will be assessed and appropriate information provided.

Required information

The information needs of patients will vary over time and often need to be tailored to their capacity and mental state at different stages of their illness. The principle of the recent Montgomery ruling, is that patients are provided with information regarding material risks of treatment sufficient to allow a ‘reasonable’ person to make an informed choice. Alternative treatments should also be discussed. In the context of lithium such information will cover

  • What it is
  • What it is for
  • How it works
  • How long treatment is likely to last
  • Benefits of treatment
  • The need and rationale for regular blood tests (explaining the frequency and purpose) and physical health checks
  • How to take it including what to do about missed doses
  • Very common and common side effects and what to do about them
  • Signs, symptoms and causes of toxicity
  • Lifestyle advice
  • Significant interactions especially NSAIDs and anti-hypertensives
  • Family planning and pregnancy where appropriate
  • Compliance advice

With these topics in mind the following resources are recommended to clinical staff to use to provide information to potential patients or existing patients prescribed lithium.

Resources

Recommended sources of Information

Choice and Medication website

This includes a variety of patient information leaflets (in a variety of formats and languages), handy fact sheets and handy charts. These will be used to provide detailed information and reinforce verbal counselling to all prospective lithium patients and on specific issues for existing patients.

Bipolar Scotland

Provides a range of support materials and information for people with Bipolar disorder

Royal College of Psychiatrists

Provides a range of support materials and information for people with Bipolar disorder

Birmingham University

Provides a range of leaflets specifically for people with reading or learning difficulties.

NHS GG&C lithium information leaflets

These leaflets were developed jointly by mental health services and Bipolar Scotland as part of the development work for the Bipolar Hub project. The following topics are covered

  • The importance of taking lithium regularly
  • The need for regular blood tests
  • Common interactions that affect lithium
  • Other factors that affect lithium levels
  • Common lithium side effects and what to do about them
  • Signs of toxicity

These leaflets will be issued to all prospective patients and be given to each patient prescribed lithium with their discharge prescriptions. Ward clinical pharmacists will use them to support one to one patient education. The leaflets are available from Leverndale Pharmacy.

Information produced by lithium manufacturers

The UK manufacturers provide a variety of patient information resources on lithium tailored to their product. These can be used to compliment the resources above if necessary. Contact Leverndale Pharmacy for advice.

Prospective patients

For all patients for whom lithium treatment is being considered it is the duty of the ward or CMHT multi-disciplinary team to ensure each patient’s information needs are assessed and met.

Ideally all prospective patients will have the opportunity to discuss treatment with a clinical pharmacist prior to treatment starting.  However this may not always be possible in which case appropriate members of the MDT will provide the information as outlined in the information resources section above.

Consideration with regards to the level of initial information provided may depend on the patient’s mental state at the time.

Established patients

Appropriate members of the MDT whether that be in hospital wards or community mental health teams will regularly assess and meet the information needs of patients prescribed lithium under their care. They will use the resources outlined above to meet those needs.

Editorial Information

Last reviewed: 07 April 2020

Next review: 01 April 2023

Author(s): PMG-MH

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke