Role of nurses in the initiation and the monitoring of Lithium

Abstract

Introduction Lithium is the oldest known treatment of bipolar disorders and remains the gold standard. Nevertheless, it remains difficult to handle, largely due to its narrow therapeutic index and its long-term side effects. Thus, it requires special initiation and monitoring measures. Objectives This study aims to assess nurses’ knowledge and attitudes regarding lithium. A protocol on Lithium initiation and monitoring will be established. Methods This is a descriptive study including 20 nurses in a psychiatry department conducted from January to May 2021 based on an self-assessment questionnaire that was established to assess nurses’ knowledge about Lithium, its side effects, initiation and monitoring. Results None of the recruited nurses had any training regarding the use of lithium. The vast majority of subject (85%) said that lithium’s dosage must be individualized and adaptable to each patient throughout a specific blood test. 90% recognized renal failure as the most common contraindication of lithium. Complete Blood Count (CBC), and renal check-up were the only tests recognized as necessary by all the sample subjects. 90% answered that lithium is toxic and 65% answered that it is fatal. In case of toxicity by lithium all subjects (100%) agreed to call the responsible doctor of the patient, 25% of them chose it as a unique measure and 75% thought it was necessary to stop the lithium immediately as well. Conclusions Lithium is considered as a double-edged sword largely due to its narrow therapeutic index. Nevertheless, nurses are undertrained when it comes to its use and manipulation. Disclosure No significant relationships.

Keywords

• monitoring
• Nurses
• initiation
• Lithium