Impact of the addition of a clinical pharmacist to a community hospital psychiatric consult liaison team.

The objective of this data analysis was to assess the impact of the addition of a clinical psychiatric pharmacist to a community hospital inpatient psychiatric consult liaison team. Consult liaison psychiatry deals with medically ill patients in general hospital settings and involves the timely recognition and treatment of mental health conditions while coordinating with other medical providers. Each patient consulted to the psychiatry team was reviewed by the clinical pharmacist. Recommendations made by the clinical pharmacist were tracked over a 9-month period. During that time frame, 596 opportunities for intervention were identified. The largest proportion of identified opportunities for intervention were related to admission medication reconciliation, equating to roughly 30%. Optimization of safe medication use had the second largest number of opportunities for intervention at approximately 27%. Additional data, such as time spent on patient care, reason for consultation, and number of accepted recommendations based on medication class/type of intervention, were collected.

False lithium toxicity secondary to lithium heparin test tube: A case report and review.

This case demonstrates a false elevation of serum lithium concentrations that can occur when blood samples are collected using lithium heparin (green-top) tubes. The patient was a 58-year-old female on chronic lithium therapy for bipolar disorder who presented to the emergency department following an overdose of 5 unidentified medications. The patient was overly sedated and exhibited paradoxical laughter, slurred speech, and mild abdominal pain. The recommended maintenance lithium concentration is 0.6 to 1.0 mmol/L, and she had previously been stable within this therapeutic range. The initial lithium concentration drawn upon admission was 2.05 mmol/L. No intervening treatment was made with the exception of intravenous fluids due to a lack of correlation between clinical presentation and the lithium concentration. Six hours later, a repeat lithium concentration of <0.10 mmol/L was obtained. Upon investigation, it was discovered that the initial blood sample was obtained in a lithium heparin green-top tube instead of the recommended plastic tubes with either sodium heparin or dipotassium ethylenediamine tetraacetic acid as the anticoagulant. As this case demonstrates, lithium heparin tubes have the potential to cause falsely elevated lithium concentrations. It is important for health care professionals to be aware of the false elevations that can occur when blood samples are taken in this type of tube.