title: Pharmacist impact on posttraumatic seizure prophylaxis in patients with head injury.
abstract: Phenytoin is the most commonly administered antiepileptic agent for the prevention of early (< or = 7 days) posttraumatic seizures. Use of the agent, however, requires strict monitoring due to its narrow target range and nonlinear pharmacokinetics. The impact of a clinical pharmacist participating in the care of patients with head injury on posttraumatic seizure prophylaxis with regard to phenytoin dosing and monitoring, cost avoidance, and patient outcome, was measured retrospectively. Parameters from time periods before (BP) and after (AP) a clinical pharmacist participated in patient care were compared. The average number of days that phenytoin was given was 13.4 (BP) and 7.6 (AP), and the duration of phenytoin prophylaxis was 7 days or less in 35% and 65% of patients, respectively. The average number of phenytoin levels drawn from each patient was 10.3 (BP) and 3.4 (AP). Seizures occurred in 4.7% (BP) and 1.5% (AP) of patients. A cost savings of approximately $28,000 was observed for the AP group. A clinical pharmacist reduced the use of posttraumatic seizure prophylaxis and associated costs without jeopardizing patient outcomes.
authors.affiliation: Virginia Commonwealth University, Medical College of Virginia Campus, Richmond 23298-0533, USA.
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Brophy
authors.forename: Eljim P
authors.initials: EP
authors.lastname: Tesoro
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Schrote
authors.forename: William R
authors.initials: WR
authors.lastname: Garnett
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000150:complications* / Q000188:drug therapy; D004512:Education, Pharmacy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000191:economics; D010672:Phenytoin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin