Clinical Pharmacist Intervention in an Extended Care Facility

Abstract

A four-month study was conducted at an extended care facility to determine if Jelliffe's method of digoxin dosing yielded a lower incidence of digoxin toxicity without loss of therapeutic efficacy, as compared with an established way of dosing.

The study was divided into two phases. During both phases, all patients at an extended care facility taking oral digoxin were monitored for signs and symptoms of both digoxin intoxication and digoxin underdosage. The same patients were studied in both phases, and the number and frequency of observations made on these patients was also identical. Serum digoxin, potassium, and creatinine levels, and electrocardiograms were obtained monthly to aid in the documentation of digoxin underdosage or toxicity. In Phase I (control), the patients' digoxin regimens were determined by physician order without any pharmacist intervention. In Phase II (study), all patients were dosed based upon the calculations made by the clinical pharmacist using Jelliffe's method.

Clinical pharmacist intervention with the use of Jelliffe's method for digoxin dosing yielded a statistically significant decrease in toxicity and a decreased incidence of digoxin underdosage in Phase II as compared with Phase I, without any compromise in therapy.