Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model

Abstract

Background Therapeutic drug monitoring (TDM) of Vancomycin (VCM) is required to prevent inappropriate dosage-associated bacterial resistance, therapeutic failure, and toxicities in pediatrics. Anecdotal experience and studies show that many healthcare institutions confront barriers while implementing TDM services, this study aimed to assess a pharmacist-directed VCM–TDM service for optimizing patient care in our institution. Materials and methods Patients aged 1 month–18 years who received intravenous VCM were included in this quasi-experimental study. The pre-implementation phase (March–June 2018) consisted of retrospective assessment of pediatric patients, the interventional phase (July 2018 to February 2020) included educational programs and the post-implementation phase (March–June 2020) evaluated the participants based on pharmacist-directed VCM–TDM services as a collaborative-practice model including clinical and inpatient pharmacists to provide 24/7 TDM services. Outcomes of the study included the mean difference in the number of optimal (i) prescribed initial VCM doses (primary) (ii) dosage adjustments and (iii) VCM-sampling time (secondary). After ethical approval, data were collected retrospectively. Results A hundred patients were there in each phase. The number of cases who were correctly prescribed initial VCM doses was significantly higher in the post-implementation phase, mean difference of 0.22, [95% CI (0.142–0.0.358), p < 0.0001]. Patients who had correct dosage adjustments in the post-implementation phase also had higher statistical significance, mean difference of 0.29, [95% CI (0.152–0.423), p < 0.05]. More correct practices of VCM-levels timing were observed in the post-implementation phase, mean difference of 0.15, [95% CI (− 0.053–0.264), p = 0.079]. Conclusion This study showed the significant role of pharmacist-directed TDM services to optimize the correct prescribing of initial VCM doses and dose adjustments.

Vancomycin prescribing and therapeutic drug monitoring: Challenges of real clinical practice

“…For instance, the expansion of pharmacists’ role in an orthopedic unit in Australia ensured correct weight-based dosing and SAP duration [ 22 ]. In another recent quasi-experimental study, pharmacists had a pivotal role in optimizing the initial vancomycin doses and dose adjustments [ 23 ].…”

Leveraging Clinical Pharmacy Expertise for Pediatric Cardiology in Low and Middle-Income Country

“…[16][17][18] Recently, it has been observed that this profession is gradually growing in Pakistan in private set-up. [19][20][21] However despite this improvement, the precise role of pharmacist as healthcare profession in Pakistan is still challenging. Within the sphere of pediatric cardiac setting, a notable scarcity of substantial data prevails in Pakistan, illuminating the comprehensive elucidation of the pivotal role and engagement of pharmacist in clinical activities.…”

Pharmacist-Managed Therapeutic Drug Monitoring Programs within Australian Hospital and Health Services—A National Survey of Current Practice

“…Evidence also suggests the integration of pharmacy services in TDM can impact positively on patient care, with improved sampling time and clinical interpretation of drug levels leading to more efficient and cost-effective delivery of care [ 12 , 13 ]. There is evidence to suggest that, when pharmacists are directly involved in ordering pathology and dose adjustments, substantial cost savings can be demonstrated by reducing inappropriate requests and increasing the optimization of initial dosing for medications such as antibiotics [ 12 , 13 , 14 , 15 ]. Although evidence has demonstrated the benefits of these TDM services, the extent to which healthcare settings in Australia have made use of the knowledge and skills of pharmacists to provide high-level, patient-focused services within this area is not known [ 16 , 17 ].…”