Outpatient drug monitoring

The distinction between inpatient and outpatient monitoring is only a procedural one. For many adverse reactions to drugs, a comprehensive study requires both inpatient and outpatient data even though either setting alone may provide sufficient information to incriminate the drug (Friedman et al. 1971 Kurland et al. 1978 Maronde et al. 1978 Skegg 1978). 

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Friedman GD, Collen MF, Harris LE, et al. Experience in monitoring drug reactions in outpatients the Kaiser-Permanente Drug Monitoring System. ]AMA 1971 217 2498. 

In addition to administering the drug, the nurse monitors the therapeutic response (desired response) and reports adverse reactions. In the home setting, the nurse is responsible for teaching the patient and family members the necessary information to administer drugp safely in an outpatient setting. 

The patient will usually take these drugs on an outpatient basis and come to the clinic or the primary health care provider s office for periodic monitoring. Frequent monitoring of blood cholesterol and triglyceride levels is done as a part of the ongoing assessment. 

Clonidine. This drug is now well established on the withdrawal of opiate addiction. However, due to its ability to produce postural hypotension and sedation, its use is often limited to in-patients. It is being used for out-patients in some centres but it is necessary to ensure daily contact with the patients so any side effects, particularly low blood pressure, can be monitored and this may be possible for example through the Community Psychiatric Nurse (CPN) of a Community Drugs Team. Further work is needed in its use for outpatients before it can be generally recommended. 

Service delivery is the interface between the healthcare system and its patients where the ultimate goal is effective treatment of health problems. This decision point encompasses inpatient and outpatient care, drug administration or dispensing and counseling, ADE monitoring, and patient compliance. 

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