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Background: Lithium is a commonly used drug with a narrow therapeutic index, it has significant adverse effects on kidney and thyroid, and is life threatening during intoxication. Maudsley guidelines on managing bipolar affective disorder patients (BPAD) with lithium recommends checking weight at baseline and every 3rd month, serum lithium after 7th day thereafter 3 months once, renal function test and serum thyroid stimulating hormone (TSH) at baseline and 6 months once. Aim: To evaluate whether Pre-Lithium workup and monitoring is done in Bipolar affective disorder (BPAD) patients initiated on Lithium as per Maudsley prescribing guidelines in psychiatry. Method: Retrospective audit conducted in a tertiary care hospital on lithium monitoring in BPAD patients treated with lithium atleast for six months compared against Maudsley prescribing guidelines. Results: Among medical records of 114 bipolar patients fulfilling study criteria, weight and serum lithium at baseline was checked in 100% of patients; serum creatinine and TSH at baseline along with lithium at 3rd month was done in 83.3%, 78.9% and 68.4% of patients respectively. Maudsley guidelines for serum creatinine, TSH and lithium level at 6th month were met only in 43.8%, 43.8% and 72.8% of patients respectively. Conclusion: The quality of lithium monitoring in bipolar patients falls well short of accepted standards; Hence addressing the issues in monitoring and following a standard protocol can improve the effectiveness of treatment and quality of life of patients.