Monitoring patients for lithium toxicity

A colleague of mine is doing a project on lithium toxicity for his clinical ladder. He found that some hospitals have protocols for when lab work must be done for this drug as there are some patients that are much more at risk for toxicity. In those hospitals, the clinical course is scrutinized closely, and there are committees that oversee outcomes. But alas, on our unit, the patients are solely in the hands of the doc running the unit.

We had an elderly female patient that ended up in ICU with lithium toxicity this past year. This doc blamed the nursing staff for her outcome. Yet staff did alert the doctor to her symptoms of toxicity. And, this doctor did not order labs to be drawn as often as drug manuals indicated that they should have been.

My colleague continues to research these cases though he was told not to report his information to adminstration by our nurse manager. He is finding that this doctor has made no change in how he orders his labwork despite increased risk factors for some of our patients.

Would this be a risk management issue?