Educational intervention to improve appropriate digoxin therapeutic drug monitoring: a quasi-experimental study.
digoxin
education
heart failure
serum digoxin concentration
therapeutic drug monitoring
Journal
European journal of hospital pharmacy : science and practice
ISSN: 2047-9956
Titre abrégé: Eur J Hosp Pharm
Pays: England
ID NLM: 101578294
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
28
08
2019
revised:
24
09
2019
accepted:
30
09
2019
entrez:
26
10
2021
pubmed:
27
10
2021
medline:
2
4
2022
Statut:
ppublish
Résumé
Our previous retrospecive study evaluating the appropriateness of serum digoxin concentration (SDC) measurements revealed errors in the timing of blood specimen collection in 98% of the tests. The aim of this study is to evaluate the appropriateness of the SDC measurements and the factors involved in inappropriate test-ordering, after training health personnel in digoxin therapeutic drug monitoring. This is a training-based quasi-experimental study. The residents and nurses of the Cardiology Clinic were trained first in December 2017, and refresher training courses were carried out every month throughout the study. The medical data of the inpatients receiving digoxin therapy were recorded prospectively, between January and December 2018. The appropriateness of the physicians' orders for SDC measurement was evaluated according to the criteria of the right indication and right timing of blood collection. The results are presented by descriptive statistics, Student's t-test and χ A total of 232 SDC tests were ordered for 121 patients (age: 71.0±12.6 years, 56.2% women). Of these orders,129 (55.6%) were considered appropriate: 205 (88.4%) for indication and 129 (62.9%) for blood collection timing. There was a significant correlation between inappropriate order for SDC test and the age of the patient, female gender, impairment of renal function tests, high levels of serum BNP and the number of medications used (P<0.005). Approximately a one-half decrease in inappropriate tests compared with our previous study results imply that education has a positive effect on physician behaviour. However, physicians' concerns due to increased risk factors for the patient still play a role in inappropriate test-ordering.
Identifiants
pubmed: 34697048
pii: ejhpharm-2019-002078
doi: 10.1136/ejhpharm-2019-002078
pmc: PMC8552125
doi:
Substances chimiques
Digoxin
73K4184T59
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
320-324Informations de copyright
© European Association of Hospital Pharmacists 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Ther Drug Monit. 1992 Feb;14(1):81-4
pubmed: 1546395
Ther Drug Monit. 2005 Feb;27(1):10-7
pubmed: 15665740
Am J Cardiol. 2019 Jan 1;123(1):69-74
pubmed: 30539748
Biochem Med (Zagreb). 2018 Feb 15;28(1):010901
pubmed: 29187799
Seizure. 2011 Mar;20(2):126-30
pubmed: 21106405
J Clin Pharm Ther. 1992 Jun;17(3):173-4
pubmed: 1639878
Arch Intern Med. 1998 Dec 7-21;158(22):2444-9
pubmed: 9855382
Korean J Intern Med. 2009 Mar;24(1):1-10
pubmed: 19270474
Arch Intern Med. 1999 Feb 22;159(4):363-8
pubmed: 10030309
Drugs Aging. 2000 Nov;17(5):353-62
pubmed: 11190416
J Am Coll Cardiol. 2002 Mar 20;39(6):946-53
pubmed: 11897434
Circulation. 2017 Aug 8;136(6):e137-e161
pubmed: 28455343
Ther Drug Monit. 1990 Mar;12(2):173-81
pubmed: 2315974
Clin Pharmacokinet. 2003;42(2):107-21
pubmed: 12537512
Ann Pharmacother. 1996 May;30(5):449-54
pubmed: 8740321
Circ J. 2017 Mar 24;81(4):581-612
pubmed: 28302953
J Hosp Med. 2016 Dec;11(12):869-872
pubmed: 27520384
Eur Heart J. 2006 Jan;27(2):178-86
pubmed: 16339157
Swiss Med Wkly. 2002 Sep 7;132(35-36):506-12
pubmed: 12506332
J Am Coll Cardiol. 2013 Jun 25;61(25):2495-502
pubmed: 23563132
JAMA. 2003 Feb 19;289(7):871-8
pubmed: 12588271
Basic Clin Pharmacol Toxicol. 2014 Nov;115(5):432-7
pubmed: 24703163
Curr Opin Nephrol Hypertens. 2004 Mar;13(2):163-70
pubmed: 15202610
Aust Fam Physician. 2013 Jan-Feb;42(1-2):18-22
pubmed: 23529454
J Manag Care Pharm. 2011 Nov;17(9):695-700
pubmed: 22050394
Clin Chem. 1998 Feb;44(2):401-7
pubmed: 9474051
Eur J Clin Pharmacol. 2007 Dec;63(12):1201-2
pubmed: 17874318