Compliance with criteria necessary for effective drug concentration monitoring

Drug concentration monitoring (DCM) has become a widely used tool in clinical medicine. However, optimal benefit from this service is most likely if there is close adherence to specific guidelines governing the initiation of, interpretation of, and clinical response to each DCM request. This study was designed to identify deficiencies in the clinical utilization of the DCM service at St. Vincent's Hospital, Sydney, and to test the effect of an intervention process designed to correct these deficiencies. Audit criteria describing appropriate indications for DCM, clinical data required to interpret DCM results, and actions to be taken in response to a result outside the therapeutic range were used to assess the performance of DCM. The results obtained from the baseline survey were used to devise educational material for the resident medical staff and to assist in the revision of the DCM request form. There was a clinically and statistically significant increase in the number of DCM results that satisfied the audit criteria after the intervention process.