1. Arthur, A, Dosage Systems; Benefits of dosage systems, GP, 2008, April, p 89 Emma Kirkham1,2, James Desborough1, Jane Skinner1, Stephen Bazire2,1, Timothy Anderson2 1University of East Anglia, Norwich, UK, 2Norfolk and Suffolk NHS Foundation Trust, Norwich, UK There is an actively managed database and register in Norfolk for lithium called SystemTDM® which incorporates prompts to prescribers for any out-of-range monitoring parameters. The number of patients who have a re-test within 7 days after a high lithium level has significantly increased and the time taken for a high level to return within range has significantly decreased Lumacaftor cost over the timeframe 2005–2012. The speed of prescriber

responses to high levels could impact on patient safety and minimise adverse event reports

due to monitoring of lithium. Lithium requires close serum level monitoring to ensure levels remain within the therapeutic range to minimise the risk of serious adverse effects or toxicity. The range of the levels suggested for a safe and effective therapeutic target for lithium levels currently lies at 0.4 – 1.0 mmol/L (1). In 2002 a Norfolk wide lithium register and database (SystemTDM®) was implemented and had been rolled out across the whole county by late 2004. This database not only incorporates a reminder service for blood tests but also alerts prescribers to lithium results that are out of the specified range prompting action. The aim of this research selleck compound was to look at the effect of the database on the response time for re-tests and time to next levels within range after a high lithium level (>1.0 mmol/L) was recorded. All relevant approvals were gained before research commenced. Lithium level results for the years 2005 and 2012 were anonymously extracted from the database for all patients registered. As the database was not rolled out across Norfolk until

mid-2004, 2005 was the first full year of the database in operation allowing not only time for transfer of patients but for the impact of the prompts to be fully realised. STATA was used for analysis and a two-sample Wilcoxon rank-sum (Mann-Whitney) test was HSP90 performed on the data for time to next test result after a result >1.0 mmol/L and on the data for time to next in-range level after a result >1.0 mmol/L. Figure 1 shows the re-test rates reported within 7 days of a lithium level <1.0 mmol/L in 2005 and 2012. Figure 2 shows the time to the next lithium level <1.0 mmol/L when a level >1.0 mmol/L had been reported in 2005 and 2012. The number of patients on the database and register in 2005 was 1727, and 1732 in 2012 and the number of tests recorded as >1.0 mmol/L was 184 in 2005 and 212 in 2012. Since the implementation of the database across Norfolk the percentage of patients who have a retest within 7 days of a high result has significantly increased (p < 0.0001).