Benchmarking assessment of therapeutic drug monitoring in small community hospitals

Analysis of a drug utilization evaluation (DUE) of the therapeutic drug monitoring (TDM) process performed by the pharmacy department at a small community hospital showed an opportunity for improvement in the TDM process. A review of the literature identified no information on best practices on which to build a model for the provision of TDM as a clinical service. The benchmarking process was utilized to evaluate the TDM services of institutions of a similar size. This evaluation included analysis of the TDM process as well as model development of TDM services. A telephone contact was used to survey 48 small community hospitals that provided TDM services. The information requested on the survey included institution demographics, institution policy on TDM, and the TDM process at that institution, TDM protocols, and level of cooperation between the pharmacy department and nursing department, laboratory department, and physical staff. The data were analyzed to identify similarities and differences between institutions and their best practices with regard TO TDM. Therapeutic drug monitoring was being performed by 43 of the 48 hospitals surveyed. Thirty-six of the 43 respondents stated that they had a formal policy on TDM. The process work flow used to TDM was similar for each institution. The pharmacy department had developed a protocol for therapeutic drug monitoring of aminoglycosides in 35 of the 43 hospitals surveyed. Those protocols feel into three categories, or models. Respondents of the 43 hospitals surveyed rated their perceived level of cooperation between the pharmacy department and laboratory, nursing, and physical staff. Analysis of the mean cooperation ratings between these departments showed no significant differences in cooperation between larger and smaller institutions in the survey. Use of the benchmarking process can be important tool for pharmacists to use when developing new services or looking at old ones. Constantly reviewing and adapting to best practices can lead to rapid improvements in an institution's services.