Bridging the Gap between Theory and Practice; the Active Role of Inpatient Pharmacists in Therapeutic Drug Monitoring

Abstract

Many hospitals face barriers in the implementation of TDM services, this study aimed to evaluate a pharmacist-led TDM service to optimize patients’ outcomes. Adult patients who were administered vancomycin, gentamicin, or amikacin were included. The pre-phase included a retrospective assessment of patients and the intervention phase consisted of an educational program. The post-phase assessed patients based on TDM services provided by inpatient pharmacists on a 24-h, 7-day basis for 3 months. The primary outcome was to assess the mean difference in proportion of correct initial doses of prescribing orders. Secondary outcomes included assessing the mean differences in proportions of correct dose adjustments and correct drug sampling time. Seventy-five patients in each phase were eligible. Patients who received optimal initial dosing in the post-phase showed a higher statistical significance, mean difference of 0.31, [95% CI (0.181–0.4438), p < 0.0001]. Patients in the post-phase received more optimal dose adjustments, mean difference of 0.1, [95% CI (−0.560–0.260), p = 0.2113]. Drug levels were ordered more correctly in the post-phase, mean difference of 0.03, [95% CI (−0.129–0.189), p = 0.7110]. This study demonstrated the important role of TDM services led by pharmacists in optimizing the initial dosing for these antibiotics.

Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations

“…Furthermore, antimicrobial stewardship teams are widely initiated in hospitals worldwide and it has been suggested that these teams should also include a pharmacist. The pharmacist could aid in choosing the best drug formulation to use, consult on appropriate empirical and prophylactic approaches, promote switching from intravenous to oral antimicrobials, analyse drug interactions and provide information about pharmacokinetics and TDM including prescribing of the new dose based on the TDM results. Besides this, the team should be advising appropriate antimicrobial therapy taking the specific patient and condition, documenting and analysing resistance patterns into account.…”

Knowledge, Attitude and Practice of Community Pharmacists Regarding Antibiotic Use and Infectious Diseases: A Cross-Sectional Survey in Hungary (KAPPhA-HU)

“…Adequate knowledge itself does not guarantee proper practices. This situation is called as the "theory-practice gap," and many reports have suggested that practice is mainly influenced by the attitudes of HCPs [59].…”

Evaluation of amikacin use and comparison of the models implemented in two Bayesian forecasting software packages to guide dosing

“…Misinterpretation of C max due to inappropriate sample timing, in the absence of an AUC value, can result in inappropriate dosing decisions 29 . Targeted education of prescribers and pharmacists regarding TDM has been shown to enhance dose selection and ordering of appropriate TDM samples, 30 suggesting that this would be an appropriate intervention to improve amikacin use. However, obtaining specifically timed amikacin concentrations is difficult in practice.…”