Effects of an APN-Led Amiodarone Clinic on Adherence to Recommended Monitoring Guidelines

Evidence shows that patients receiving amiodarone therapy have not adhered to monitoring guidelines set forth by the Heart Rhythm Society. Uncertainty with responsibility for monitoring has led to the development of pharmacist-managed or multidisciplinary-managed outpatient amiodarone clinics. Some limitations have been identified in the pharmacist-managed outpatient clinics that may be overcome by advanced practice nurse (APN)-managed clinics. The purpose of this EBP project was to determine what effects an APN-led amiodarone clinic would have on adherence to amiodarone monitoring guidelines. Using the PICOT format, the clinical question was developed: Does enrollment in an amiodarone clinic compared with “usual care” change adherence to monitoring as recommended by best practice guidelines and allow for earlier recognition of adverse effects of amiodarone to decrease negative patient outcomes over a four month time period? Using King’s theory of goal attainment and the ACE Star model, guidelines for monitoring patients newly started on amiodarone therapy were implemented at a northwest Indiana cardiology practice. Following enrollment, data were collected via chart reviews and compared to a usual care group which consisted of patients seen in the office during the previous year who did not receive care based on monitoring guidelines. When the two groups were compared using the chi-square of independence, a significant difference was found in the post-amiodarone group for baseline EKG (X2 (1) = 4.56, p = .03). Although results were not statistically different for baseline TFT (X2 (1) = 1.35, p = .25), LFT, (X2 (1) = 2.55, p = .11), CXR (X2 (1) = 3.32, p = .07), and PFT (X2 (1) = 1.55, p = .21) diagnostics, those participants in the post-amiodarone clinic group were more likely to complete the recommended diagnostics. This small-scale APN-led amiodarone clinic improved amiodarone monitoring adherence leading to the possibility of future practice of APN-led therapeutic drug monitoring clinics