Pharmacist-To-Dose Dofetilide (Tikosyn®) for Medication Initiation in Atrial Fibrillation Patients

Service or Program: Pharmacist-To-Dose Dofetilide (Tikosyn®) for Medication Initiation in Atrial Fibrillation Patients Justification/Documentation: Dofetilide (Tikosyn®) is a Class III antiarrhythmic agent used to treat patients with atrial fibrillation and/or atrial flutter. Accurate dosing upon initiation of this medication is essential to prevent an accidental induced arrhythmia secondary to a prolongation of the QT. A pharmacist-to-dose order set was created to assist physicians upon ordering of dofetilide (Tikosyn®). The order set guides the consulted pharmacist to verify the physician is an approved prescriber, evaluate the patient specific medication profile for drug interactions and to assess the baseline QTc to ensure the patient is not contraindicated for treatment with dofetilide (Tikosyn®). Once appropriateness of treatment is determined, the initial dose is calculated by the pharmacist based on the patient’s estimated creatinine clearance using the Cockcroft-Gault equation. The pharmacist also ensures the proper laboratory and diagnostic monitoring orders are in place. Once dofetilide (Tikosyn®) has been initiated, the pharmacist in conjunction with the prescribing physician will evaluate each resulted QTc to ensure that continuation of the treatment at the prescribed dose is appropriate. If a dose adjustment is required, the pharmacist will contact the physician to discuss the patient case. The pharmacist will also assist in monitoring of electrolytes and ensures appropriate replacement has been administered as indicated. Transferability: Development of a pharmacist-to-dose order set within any institution requires careful education of the pharmacy staff and a physician champion to lead the initiative. This type of service is otherwise easily transferable for most inpatient settings. Impact: As stated above, the accuracy of initiation of dofetilide (Tikosyn®) therapy is extremely important to maintain patient safety and prevent adverse drug effects. The impact of this initiative could be life-saving for a patient.