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Patients will be included for this indicator if they have:

An issue for Lithium in the last 6 months (After 1st October)

Code for Lithium prescription



665B. Lithium stopped (recorded after last prescription issued)

Accepted blood test declined exception code:

41M.. Blood test declined

Then they need:

A Code for serum creatinine (In the last 9 months)

44J3. Serum creatinine
44J30 Serum creatinine abnormal
44J31 Serum creatinine low
44J32 Serum creatinine normal
44J33 Serum creatinine raised
44J3z Serum creatinine NOS
44JC. Corrected plasma creatinine level
44JD. Corrected serum creatinine level
44JF. Plasma creatinine level


And A Code for TSH recording (In the last 9 months)

442A. TSH - thyroid stim. hormone
442A0 Serum TSH level normal
442A1 Serum TSH level abnormal
442K. 30 minute plasma TSH level
442L. 60 minute plasma TSH level
442M. 90 minute plasma TSH level
442N. 120 minute plasma TSH level
442O. 150 minute plasma TSH level
442P. 30 minute serum TSH level
442Q. 60 minute serum TSH level
442R. 90 minute serum TSH level
442S. 120 minute serum TSH level
442T. 150 minute serum TSH level
442W. Serum TSH level
442X. Plasma TSH level
442e. Blood spot TSH level

Mental Health exception reporting codes(Added in the last 12 months)

9h9.. Exception reporting: mental health quality indicators
9h91. Excepted from mental health quality indicators: Patient unsuitable
9h92. Excepted from mental health quality indicators: Informed dissent


Mental health 009.1 Rationale

It is important to check thyroid and renal function regularly in patients taking lithium, since there is a much higher than normal incidence of hypothyroidism and hypercalcaemia, and of abnormal renal function tests in patients on lithium. Overt hypothyroidism has been found in between eight per cent and 15 per cent of people on lithium.

The NICE clinical guideline on bipolar disorder CG38 recommends that practitioners should check thyroid function every six months together with levels of thyroid antibodies if clinically indicated (for example, by the thyroid function tests). It also recommends that renal function tests should be carried out every six months and more often if there is evidence of impaired renal function.

Mental health 009.2 Reporting and verification

See indicator wording for requirement criteria.

Due to the way repeat prescribing works in general practice, patients on lithium therapy are defined as patients with a prescription of lithium within the preceding six months.

Prepared By Jean Keenan