Evaluation of the impact of a therapeutic drug monitoring program in a Swiss University Hospital

Details

Serval ID
serval:BIB_16C92C4C7410
Type
Inproceedings: an article in a conference proceedings.
Publication sub-type
Abstract (Abstract): shot summary in a article that contain essentials elements presented during a scientific conference, lecture or from a poster.
Collection
Publications
Institution
Title
Evaluation of the impact of a therapeutic drug monitoring program in a Swiss University Hospital
Title of the conference
ESCP-GSASA, 38th Symposium on Clinical Pharmacy, 30 years of clinical pharmacy : a bright future ahead
Author(s)
Fernandez S., Widmer N., Buclin T., Biollaz J., Csajka C.
Address
Geneva, Switzerland, November 3rd-6th, 2009
ISBN
0928-1231
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
32
Series
Pharmacy World and Science
Pages
283-284
Language
english
Abstract
Background and objective: Therapeutic Drug Monitoring (TDM) has been introduced early 1970 in our hospital (CHUV). It represents nowadays an important routine activity of the Division of Clinical Pharmacology and Toxicology (PCL), and its impact and utility for clinicians required assessment. This study thus evaluated the impact of TDM recommendations in terms of dosage regimen adaptation.
Design: A prospective observational study was conducted over 5 weeks. The primary objective was to evaluate the application of our TDM recommendations and to identify potential factors associated to variations in their implementation. The secondary objective was to identify pre-analytical problems linked to the collection and processing of blood samples.
Setting: Four representative clinical units at CHUV.
Main outcome measure: Clinical data, drug related data (intake, collection and processing) and all information regarding the implementation of clinical recommendations were collected and analyzed by descriptive statistics.
Results: A total of 241 blood measurement requests were collected, among which 105 triggered a recommendation. 37% of the recommendations delivered were applied, 25 % partially applied and 34% not applied. In 4% it was not applicable. The factors determinant for implementation were the clinical unit and the mode of transmission of the recommendation (written vs oral). No clear difference between types of drugs could be detected. Pre-analytical problems were not uncommon, mostly related to completion of request forms and delays in blood sampling (equilibration or steady-state not reached). We have identified 6% of inappropriate and unusable drug level measurements that could cause a substantial cost for the hospital.
Conclusion: This survey highlighted a better implementation of TDM recommendations in clinical units where this routine is well integrated and understood by the medical staff. Our results emphasize the importance of communication with the nurse or the physician in charge, either to transmit clinical recommendations or to establish consensual therapeutic targets in specific conditions. Development of strong partnerships between clinical pharmacists or pharmacologists and clinical units would be beneficial to improve the impact of this clinical activity.
Keywords
Clinical pharmacokinetics Therapeutic drug monitoring Therapeutic management Clinical interpretation
Web of science
Create date
30/11/2010 9:47
Last modification date
20/08/2019 12:46
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