title: Clinical outcomes of the inclusion of the therapeutic drug monitoring report in the electronic clinical record.
abstract: OBJECTIVE
  To assess the inclusion of the Therapeutic Drug Monitoring Report (TDMR) in the Electronic Clinical Record (ECR).
  
  
  METHODS
  An observational ambispective cohort study with a duration of 149 days: PRE (retrospective, 49 days) with the TDMR printed in paper, and POST (prospective, 100 days) with the TDMR included in the ECR.
  
  
  METHODS
  Patients not hospitalized, applications for Therapeutic Drug Monitoring by Critical Care and Neonatal Units, as well as monitoring with an objective other than dose adjustment.
  
  
  METHODS
  Number of TDMRs prepared, number of patients admitted with TDMR, time of delay for treatment adjustment, defined as the number of adjustments made to the treatment within over or under 24 hours from the time of TDMR preparation, and medication errors (MEs) associated with said delay, as well as the degree of acceptance of the TDMR.
  
  
  RESULTS
  690 TDMRs were conducted in 391 patients, 339 in PRE (n = 206) and 351 in POST (n = 185). The number of treatment modifications made in under 24 hours increased from 73.9% in PRE to 87.3% in POST [RR = 1.2 (CI95% = 0.97-1.43). We identified 35 patients with ME, 9.7% of them in PRE and 8.1% in POST (RR = 0.84 (CI95% = 0.44-1.58)]. The degree of acceptance of the pharmacist recommendation increased from 53.3% in PRE to 68.3% in POST [RR = 1.3 (CI95% = 1.02- 1.62)].
  
  
  CONCLUSIONS
  The inclusion of the Therapeutic Drug Monitoring Report (TDMR) in the Electronic Clinical Record increases the degree of acceptance of recommendations, and may reduce the delay in treatment modifications, reducing MEs and improving the process quality in terms of efficacy and safety.
authors: Pharmacy Unit. Hospital Universitario Dr. Peset. Valencia,. saez_marbel@gva.es.
authors: Marina
authors: M
authors: Sáez Belló
authors: Pharmacy Unit. Hospital Universitario Dr. Peset. Valencia,. saez_marbel@gva.es.
authors: Ana
authors: A
authors: Moya Gil
authors: Pharmacy Unit. Hospital Lluís Alcanyís de Xàtiva, Valencia. Spain.. saez_marbel@gva.es.
authors: M Ángeles
authors: MÁ
authors: López Montenegro Soria
authors: Pharmacy Unit. Hospital Universitario Dr. Peset. Valencia,. saez_marbel@gva.es.
authors: Pablo
authors: P
authors: Sánchez Sancho
authors: Pharmacy Unit. Hospital Universitario Dr. Peset. Valencia,. saez_marbel@gva.es.
authors: Pau
authors: P
authors: Frias Ruiz
authors: Pharmacy Unit. Hospital Universitario Dr. Peset. Valencia,. saez_marbel@gva.es.
authors: Mónica
authors: M
authors: Climente Martí
mesh_terms: D015331:Cohort Studies; D016903:Drug Monitoring / Q000379:methods*; D057286:Electronic Health Records; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome