Quality of requests for serum digoxin concentrations: experience from an Australian regional health service.
BACKGROUND
* Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. * The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. * A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems.


CONCLUSIONS
* The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. * Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings.


OBJECTIVE
To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service.


METHODS
We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice).


RESULTS
The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties).


CONCLUSIONS
The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed.
Ellington
Chris
C
Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, SA, Australia.
Grgurinovich
Nick
N
Miners
John O
JO
Mangoni
Arduino A
AA
D000889:Anti-Arrhythmia Agents / Q000097:blood*; D002316:Cardiotonic Agents / Q000097:blood*; D004077:Digoxin / Q000097:blood*; D016903:Drug Monitoring / Q000379:methods / Q000592:standards*; D005194:Family Practice / Q000592:standards; D006761:Hospitals / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D008485:Medical Audit; D008511:Medicine / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D013021:South Australia; D013038:Specialization
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004077:Digoxin