Blood, dose recommendation reports and phone calls: experiences of a therapeutic drug monitoring advisory service for vancomycin
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Date
2023
Authors
Carland, J.E.
Stacy, A.E.
Schaffer, A.L.
Day, R.O.
Brett, J.
Reuter, S.E.
Stocker, S.L.
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British Journal of Clinical Pharmacology, 2023; 89(6):1896-1902
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Abstract
Dose-prediction software is recommended to enable area under the curve over 24 h (AUC(24))-guided dosing of the antibiotic vancomycin. However, uncertainty remains about how best to implement software in the clinic. We describe the activity, over 18 months, of a consultative therapeutic drug monitoring Advisory Service (the Service) for vancomycin that used dose-prediction software alongside clinical expertise, identifying factors that influence attainment of therapeutic targets. Of the 408 vancomycin dose reports provided for 182 courses of therapy, most (57%) recommended a dose change. The majority (82.8%, 193/233) of recommended dose adjustments were accepted by treating teams. A dose report was not published for 125 courses of therapy, with reasons including patient in intensive care unit or service error. An estimated 26.6 h of staff time was allocated to Service activities each month. Publication of a dose report facilitated attainment of therapeutic targets (P = .002). Software integration could improve Service outcomes, avoiding errors and reducing staff workload.
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Copyright 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society. This is an open access article under the terms of the Creative Commons Attribution-Non Commercial-No Derivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/)