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

Introduction: Studies examining educational interventions led by pharmacists to minimize negative outcomes associated with elevated and potentially harmful lithium levels in inpatient psychiatric facilities are lacking. Other studies indicate a need for improvement of therapeutic drug monitoring for lithium. The aim of this article is to identify potential improvements in negative outcomes associated with harmful lithium blood levels after educational interventions are delivered by a clinical pharmacist to providers of an inpatient psychiatric facility. Methods: Medication reports were queried from the pharmacy database to identify all patients who were taking lithium within 1 year. Laboratory results, physician progress notes, nursing progress notes, and treatment plans were studied to detect any adverse events associated with lithium levels. Educational interventions created by pharmacy services were tailored toward medical staff and delivered over a 3 month period. Learning was assessed at pre-educational and posteducational interventions. Results: One hundred fifteen patients received lithium between March 2012 and March 2013. The most-frequent adverse effects reported associated with lithium included tremor, dizziness, slurred speech, and lethargy. Two patients were sent to the local emergency department for lithium toxicity and required dialysis. Fifty-two patients received lithium after educational interventions, and no adverse events were reported. A lithium drug-monitoring spreadsheet was created for pharmacy use, and drug-monitoring guidelines were revised and disseminated throughout the facility. Discussion: A reduction in negative outcomes associated with lithium was noted after educational interventions to medical staff occurred. The impact of pharmacist-led educational interventions demonstrated a high potential for success.