Implementation of a Novel Order Set to Improve Baseline Pulmonary, Hepatic, and Thyroid Function Testing at Time of Inpatient Amiodarone Initiation

Amiodarone is a chemically-unique class III antiarrhythmic drug and is commonly-prescribed by internists and cardiologists alike.1 In addition to its known blockade of myocardial outward potassium channels and resultant class III properties, amiodarone is pharmacologically complex and exhibits class I, II, and IV effects as well. [...]it is a common choice in the management of both supraventricular and ventricular arrhythmias, especially in patients with underlying structural heart disease.1,2 Unfortunately, the lipophilic properties of amiodarone potentiate adverse systemic effects when the drug is administered chronically, including pulmonary, thyroid, and hepatic toxicity.1–4 Though current guidelines recommend a baseline evaluation before initiating chronic oral amiodarone therapy, including pulmonary, thyroid, and liver function tests,4,5 adherence to these guidelines is poor.6 Given our sense that our institution was not meeting baseline testing guidelines for inpatients initiated on chronic oral amiodarone therapy, we developed a multidisciplinary team to construct and implement a guideline-based amiodarone initiation order set. [...]ordering data for patients discharged from May 2019 to March 2020 (n = 495) were reviewed in a similar fashion to baseline data. [...]we developed and implemented a novel order set in an attempt to improve ordering of baseline screening for inpatients started on oral amiodarone therapy.