Audit Exposes Flawed Blood Sampling for “Digoxin Levels”

Kumana, Cyrus R.; Chan, Yew Meng; Kou, Maybelle

doi:10.1097/00007691-199204000-00014

Cited by 7 publications

(13 citation statements)

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“…Previous reports published over the last 25 years have assessed the quality of the digoxin therapeutic monitoring services [6–10]. Clague et al.…”

Section: Discussionmentioning

confidence: 99%

“…Kumana et al. reviewed 172 SDC requests and observed that the information on the time elapsing between the last dose and blood sampling was lacking in 31.4% of cases [8]. More recently, Sidwell et al.…”

Section: Discussionmentioning

confidence: 99%

“…The quality of requests for SDC has been reported to be generally unsatisfactory in previous reports [6–10]. These studies, however, have generally assessed a relatively small number of requests over a short period of time.…”

Section: Introductionmentioning

confidence: 99%

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Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

Grgurinovich

Miners

et al. 2007

Brit J Clinical Pharma

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What is already known about this subject • 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. What this study adds • 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. Aims 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.

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“…Previous reports published over the last 25 years have assessed the quality of the digoxin therapeutic monitoring services [6–10]. Clague et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

Grgurinovich

Miners

et al. 2007

Brit J Clinical Pharma

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“…1,5 Even when all the data are supplied by the requesting practitioner, experience has shown that the required data can be di¤cult to transcribe, due to poor legibility.…”

Section: Discussionmentioning

confidence: 99%

Improving the quality of information on pathology request forms

2004

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“…The main indications for digoxin TDM include monitoring toxicity, assessing patient compliance, assessing the reasons for therapeutic failure, and assessing the effects of factors that alter the pharmacokinetic of digoxin (mainly renal dysfunction & drug interactions) [6,7,8]. However, several studies reported that digoxin TDM is frequently performed inappropriately that limits its benefits & increases unnecessary costs [7,9,10,11]. Therefore three criteria for proper use of digoxin TDM were suggested including proper indications, proper sampling time and proper interpretation of the measured digoxin level [12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring and Population Pharmacokinetics of Digoxin in Jordanian Patients

Shaker¹,

Hamadi²,

Idkaidek³

et al. 2013

AJPS

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Therapeutic monitoring of digoxin and the population pharmacokinetic parameters in Jordanian patients were done. Fifty three patients visited cardiac department of Jordan University hospital participated in this study, thirty two patients had congestive heart failure (CHF), while twenty one patients had atrial fibrillation (AF). Ninety three blood samples were collected from those patients for the measurement of digoxin level using AxSYM digoxin II assay method. Serum creatinine and potassium levels were also measured, in addition to blood pressure and heart rate. Microsoft Excel and Statistica programs were used for kinetic and statistical analysis. NONMEM computer program ADVAN 4 and 2 compartment model was used for population analysis of digoxin parameters. The serum digoxin level ranged from 0.11-4 ng/ml. The percentage of all patients enrolled in this study that were out of therapeutic range was 49.05%. Serum digoxin levels were out of therapeutic range in 53.12% of patients with CHF and 42.85% in those with AF. The pharmacokinetic parameters for digoxin obtained in this study using traditional methods were: creatinine clearance CLcr (89.78 ± 45.61 ml/min), digoxin actual clearance CL (200.57 ± 154.52 L/day), volume of distribution V (541.57 ± 149.87L), t1/2(2.98 ± 2.05 day), elimination rate constant (0.41± 0.396 day -1 ). A strong correlation was also found between actual digoxin clearance with log dose normalized (R 2 =0.999), and t1/2 (R 2 = 0.875). No correlations were found between the log of the normalized dose and other pharmacokinetic parameters or potassium levels. The population pharmacokinetic parameter for digoxin obtained in this study were: CL (3.34L/h), Vc (3.27L), Vt (123L), inter-compartment clearance Q (72L/h), absorption rate constant KA (1.25h -1 ). In Jordanian patients with either AF or CHF digoxin dose adjustment based on therapeutic drug monitoring principles is recommended. Digoxin pharmacokinetics were similar to those reported in non-Jordanian patients; estimated population pharmacokinetic parameters were in agreement with literature values.

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Audit Exposes Flawed Blood Sampling for “Digoxin Levels”

Cited by 7 publications

References 0 publications

Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

Improving the quality of information on pathology request forms

Therapeutic Drug Monitoring and Population Pharmacokinetics of Digoxin in Jordanian Patients

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