Pharmacist Survey: Pharmacist Perception of Vancomycin Area Under the Curve Therapeutic Drug Monitoring

Abstract

Background: Evidence suggests the standard vancomycin trough goal of 15 to 20 mg/L for serious Staphylococcus aureus infections is associated with acute kidney injury, whereas appropriate monitoring of 24-hour area under the curve (AUC) may decrease nephrotoxicity. As a result, institutions have transitioned to AUC monitoring, the predictive pharmacokinetic/pharmacodynamic parameter of vancomycin to improve safety outcomes. However, this method may require increased pharmacist time and effort. Pharmacist perception of the practice change is largely unknown and warrants investigation. Methods: An electronic survey was disseminated via e-mail to pharmacists 5 months post-AUC implementation. Items of interest were focused on pharmacist perception, including quantity of patients monitored using AUC, justification of the practice change, differences in efficacy and safety, and changes in monitoring time requirements. Results: The pharmacist survey was distributed to 196 pharmacists and 84 responded (43% response rate). Eighty-one pharmacists had monitored patients using AUC methods. Sixty-nine percent of these respondents perceived the change to result in increased or slightly increased patient safety, 27% described no difference, and 4% stated safety was decreased or slightly decreased. Forty-two percent perceived the transition to result in increased or slightly increased efficacy, while 48% noted no difference and 10% responded that efficacy was decreased or slightly decreased. Pharmacists stated the creation of an institutional calculator decreased the time required to calculate AUC. Conclusion: After the change to AUC monitoring, pharmacists perceived improvements in safety outcomes while efficacy was at least similar if not increased.

Pharmacist and physician insight of vancomycin therapeutic drug-monitoring changes

“…One pharmacist-only vancomycin AUC implementation survey was reported with 69% of respondents believing that safety was increased or slightly increased after the implementation of vancomycin AUC. 8 Another pharmacist-only vancomycin AUC transition survey also found an overall increased perception of patient safety. 9 Based on the idea that efficacy is unlikely to be impacted regardless of TDM method due to achieving AUC ≥ 400 mg*h/L in most cases with trough concentrations >15 mg/L, it is not surprising that the respondents in our postintervention survey believed that the change would not lead to increased efficacy.…”

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

“…However, this is comparable to other recent pharmacist surveys looking at service provision both within Australia and internationally. A survey investigating pharmacists’ perceptions of vancomycin area under the curve (AUC) monitoring in Australian hospitals reported a response rate of 43%; a pre- and post-pharmacist survey on tobramycin dose recommendations in an Australian hospital reported a response rate of 30% and 23.9%, respectively; while a Polish survey of pharmacists’ knowledge, attitudes and barriers in pharmaceutical care reported a response rate of 44% [ 14 , 33 , 34 , 35 , 36 ].…”

Transitioning From Consult-Based to Automatic Pharmacy-Driven Vancomycin Management: Results From a Single, Primary Care Center

“…This finding is supported by recent surveys among pharmacists regarding perceptions of the AUC transition. 9,24 A key lesson learned from this transition was that formal communication to the staff could have been improved. This responsibility was not designated to any single person or group, and instead filtered gradually out to the staff through word of mouth.…”

“…As this is primarily a feasibility study evaluating a change in operational procedures, these methods and cohorts lack the power to evaluate cost savings and substantial clinical improvements; a notion that has been challenged with changing current practices. 24 However, decreased vancomycin exposure and safety benefits have been demonstrated with the AUC/MIC transition itself in larger studies. 27,28 Finally, there was a notable lack of proven microbiology data in both cohorts, therefor efficacy analysis was designed to demonstrate a lack of harm rather than superiority.…”