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Audit – Accurate monitoring of patients on Amiodarone

Audit – Accurate monitoring of patients on Amiodarone. Supreena Devakumar July 2009. Purpose. Patients are recommended to have routine monitoring whilst taking Amiodarone To look at whether this is being done and if there is standardised practice amongst clinicians. Background.

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Audit – Accurate monitoring of patients on Amiodarone

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  1. Audit – Accurate monitoring of patients on Amiodarone Supreena Devakumar July 2009

  2. Purpose • Patients are recommended to have routine monitoring whilst taking Amiodarone • To look at whether this is being done and if there is standardised practice amongst clinicians

  3. Background • Amiodarone is a potent anti-arrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. • The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients • Side effects include pulmonary toxicity, hyper/hypothyroidism, liver toxicity, photosensitivity • Laboratory studies to assess liver and thyroid function should be performed at least every six months.

  4. Thyroid toxicity • Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. • Abnormalities common • Up to 10% of patients • Hypothyroidism >hyperthyroidism • TFTs should be done 6 monthly (bnf)

  5. Liver toxicity • elevation of liver transaminase levels • 0.6 percent annually • Patients with liver toxicity are rarely symptomatic • Monitor every 6 months

  6. Method • Ran search on Emis for all patients taking Amiodarone • 11 patients within the practice identified • Searched records to see when last had TFTs and LFTs checked

  7. Results • 4 out of 11 patients (36%) did not have up to date TFTs • 7 out of 11 patients (63%) did not have up to date LFTs • 3 patients (27%) had both TFTs and LFTs up to date • One patient did not have TFTs since December 2002 and another had not had LFTs since May 2007

  8. Conclusion • Monitoring of patients on Amiodarone within the practice in not in keeping with current guidelines

  9. Recommendations • Bring up issue at next clinical meeting and remind clinicians of current recommendations on monitoring of Amiodarone • Alert and diary date has been put on the screen of each patient on Amiodarone to remind clinicians • Amiodarone monitoring has been added to the practice blood monitoring protocol

  10. Follow up • Plan for the practice to re-audit in 12 months

  11. Thank You

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