Establishment of a pharmacist-run dofetilide initiation clinic

Purpose: The FDA currently recommends a minimum hospital stay of 3 days for patients initiated on dofetilide (Tikosyn®). The purpose of this study is to determine if a pharmacist-driven dofetilide initiation clinic can decrease time from hospital admission to first dose through a preadmission clinic at an ambulatory cardiology practice.

Methods: A pharmacist-driven dofetilide initiation protocol was developed to screen patients and address criteria that may prolong time to first dose of dofetilide upon hospital admission. Retrospective data collected from patients initiated on dofetilide from January 1st, 2011 to June 30th, 2011 was compared to prospective data collected from patients managed in the pharmacist-run dofetilide clinic from January 1st, 2012 to March 31st, 2012. The primary outcome of this study was time from hospital admission to first dose of dofetilide. The secondary outcome of this study was total length of hospital stay.

Results: There were 8 patients included in the retrospective group and 7 patients in the prospective group. The median time from hospital admission to first dose of dofetilide was decreased by 4.4 hours (8.7 vs. 4.3, 51% change) for patients seen in the dofetilide initiation clinic. Mean length of hospitalization was decreased by 1.2 days (4.3 vs. 3.1, 28% change). It took on average 3 days longer (10 vs. 13) from when a physician planned to initiate dofetilide until patients were admitted to the hospital for dofetilide loading.

Conclusion: The dofetilide initiation clinic decreased time to first dose, decreased length of hospitalization, and increased time from plan to start dofetilide until hospital admission. The new service was well received by patients and providers and will continue to be offered in the future.