Associate Professor & HOD, Department of Pharmacology, Pandit Jawaharlal Nehru Govt. Medical College and Hospital, Chamba, H.P. India

Assistant Professor, Department of Medicine, Pandit Jawaharlal Nehru Govt. Medical College and Hospital, Chamba, H.P.India

Holy Mary college of Pharmacy, Bogaram, Keesara, Hyderabad, Telangana, India.
Therapeutic Drug Monitoring , Intensive Care Unit ,Digoxin ,Audit ,Enzyme Multiplied Immuno Technique ,

The TDM of digoxin is performed in conclusively. The process starts with the sample of the patient and estimated by proper chemical method followed by issuance of TDM report form for clinical decisions by the practitioner. It needs vigilance even after proper report is made for the optimization of TDM on individual patients. We have conducted an audit to assess the appropriateness of digoxin therapeutic drug monitoring in SKIMS Soura, Srinagar, a tertiary care where the medical ICU and cardiology is well developed. One hundred consecutive requests for digoxin concentrations in SKIMS Hospital inpatients were assessed. The case notes and hospital medication records were reviewed to determine the indication for testing, the appropriateness of the sampling time and of the subsequent alteration to dosing. In 42% of requests no clear indication for digoxin therapeutic drug monitoring (TDM) could be determined. In the remainder, ‘suspected toxicity accounted for 40% and ‘therapeutic failure for 18%. Samples were inappropriately taken within eight hours post-dose in 40% of requests. In 21% of cases, the samples did not reflect steady-state conditions. In 5% of occasions, the subsequent decision regarding dose adjustment was felt to be clearly inappropriate, and there was uncertainty regarding appropriateness in some other cases. Overall, in only 29% of requests was TDM performed appropriately with regard to indication, sampling and subsequent dose alteration.

7 , 2 , 2017