Evaluation of a digoxin pharmacokinetic monitoring service in a community hospital

This study was done to determine the effects of a pharmacokinetic service (PKS) on digoxin concentration monitoring and patient outcomes, including length of stay and toxicity measures. Two-hundred and eighteen consecutive patients with digoxin concentrations outside a target range were studied using a prospective before and after design. Demographic, diagnostic, and digoxin monitoring data were collected. The after group received PKS intervention by a clinical pharmacist. Results showed that the number of digoxin sample obtained was reduced by 22 percent in the after group and plasma concentrations were less often in the toxic range. The after group had significantly shorter lengths of stay (15.3 vs. 11.6 d) and fewer incidences of in-hospital digoxin toxicity (11.1 vs. 2.2 percent). Clinical pharmacist intervention was found to be associated with significant changes in patient outcomes, including length of stay and morbidity. The cost of the PKS was offset by savings resulting from the reduction in digoxin assays alone.