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Pharmacist-Managed Inpatient Dofetilide Initiation Program: Description and Adherence Rate Post-Root Cause Analysis.

Elena You Jung Ko1, Charles M Carpenter2, David J Gagnon3

  • 1Department of Pharmacy, Hurley Medical Center, Flint, MI, USA.

Journal of Pharmacy Practice
|April 3, 2019
PubMed
Summary

Pharmacist-managed dofetilide initiation programs improved adherence to clinical metrics after a root cause analysis (RCA). This enhanced patient safety, reducing adverse events like Torsade de pointes.

Keywords:
dofetilidepharmacist-managed programpharmacy practicequality improvement

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Patient Safety

Background:

  • Dofetilide initiation requires strict adherence to clinical metrics for efficacy and safety.
  • Maine Medical Center (MMC) implemented a pharmacist-managed program for dofetilide initiation.
  • A root cause analysis (RCA) was performed to identify areas for improvement.

Purpose of the Study:

  • To describe the pharmacist-managed dofetilide initiation program at MMC.
  • To assess adherence to 8 core clinical metrics before and after an RCA.
  • To review adverse effects of dofetilide initiation pre- and post-RCA.

Main Methods:

  • Evaluation of 100 patients undergoing elective dofetilide initiation (50 pre-RCA, 50 post-RCA).
  • Assessment of adherence to 8 core clinical metrics, including timely documentation, correct dosing, QTc monitoring, and patient education.
  • Review of adverse events, specifically Torsade de pointes.

Main Results:

  • Adherence to all core metrics increased from 14% pre-RCA to 44% post-RCA (P < .001).
  • Torsade de pointes occurred 3 times pre-RCA and 0 times post-RCA.
  • The RCA led to significant improvements in adherence to the dofetilide initiation protocol.

Conclusions:

  • Pharmacist-managed dofetilide initiation programs can be optimized through root cause analysis.
  • Improved adherence to clinical metrics enhances patient safety during dofetilide initiation.
  • The implemented changes effectively reduced adverse events associated with dofetilide therapy.