Why is the Implementation of Beta-Lactam Therapeutic Drug Monitoring for the Critically Ill Falling Short? A Multicenter Mixed-Methods Study

Barreto, Erin F.; Chitre, Pooja N.; Pine, Kathleen H.; Shepel, Kathryn; Rule, Andrew D.; Al‐Shaer, Mohammad H.; Aziz, Mohd. Hafiz Abdul; Roberts, Jason A.; Scheetz, Marc H.; Ausman, Sara; Moreland-Head, Lindsay N.; Rivera, Christina G.; Jannetto, Paul J.; Mara, Kristin C.; Boehmer, Kasey R.

doi:10.1097/ftd.0000000000001059

Cited by 5 publications

(4 citation statements)

References 45 publications

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“…We applaud the article by Barreto et al 1 that was published in a recent issue of Therapeutic Drug Monitoring. The description and evaluation of real-life experiences of the implementation of therapeutic drug monitoring (TDM) interventions, such as this publication, is essential to identify the key barriers and facilitators to successful implementation and sustained uptake of TDM.…”

Section: To the Editormentioning

confidence: 92%

“…What is notable in the work of Baretto et al 1 is the disparity in staff resources supporting the ICU at the 3 participating institutions. Sites 1 (no TDM), 2 (partial implementation), and 3 (full implementation) of beta-lactam TDM were supported by 42, 11, and 2.25 full-time equivalent ICU pharmacists, respectively, with pharmacist/ patient ratios of 0.21, 0.055, and 0.054, respectively.…”

Section: To the Editormentioning

confidence: 99%

“…Using social network analysis, Creswick and Westbrook 7 found that, within a multidisciplinary team, pharmacists provided medicationrelated advice to the greatest number of people. As such, pharmacists are perfectly positioned to achieve the "3E's" required to successfully implement TDM 1 -"evidence, exposure, and experts. "…”

Section: To the Editormentioning

confidence: 99%

“…Inadequate management of matrix effects can lead to diminished performance in analytical assays. 1 Busulfan is used for myeloablation before hematopoietic stem cell transplantation. Therapeutic drug monitoring (TDM) of busulfan levels in blood plasma is essential for optimizing clinical outcomes.…”

Section: Therapeutic Drugmentioning

confidence: 99%

See 3 more Smart Citations

Crying Over Stark Differences: Resource Disparity and Therapeutic Drug Monitoring

Carland,

Stojanova,

Lau

et al. 2024

Therapeutic Drug Monitoring

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Section: To the Editormentioning

confidence: 92%

Section: To the Editormentioning

confidence: 99%

Section: To the Editormentioning

confidence: 99%

Section: Therapeutic Drugmentioning

confidence: 99%

See 2 more Smart Citations

Crying Over Stark Differences: Resource Disparity and Therapeutic Drug Monitoring

Carland,

Stojanova,

Lau

et al. 2024

Therapeutic Drug Monitoring

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Defining International Critical Care Pharmacist Contributions to Sepsis and Exploring Variability

Oakley,

Al-Mahdi,

Guntschnig

et al. 2023

Curr Infect Dis Rep

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Purpose of Review To define international clinical pharmacist contributions to managing sepsis in critically unwell patients and explore variation. Recent Findings Clinical pharmacists improve clinical outcomes and cost efficiencies. They provide pharmaceutical advice on selection, administration, plus monitoring of antimicrobials and supportive therapies. Logistical activities reduce drug administration times. Guideline production, patient/clinician education, prescribing error identification, plus therapeutic optimisation activities are also reported. Summary A survey incorporating semi-structured interviews identified further antimicrobial stewardship, prescribing and digital contributions to optimise sepsis management. However, disparities associated with multidisciplinary team integration and intensive care unit service provision were found. Variability was attributed to multifaceted physical, social, financial, training and education themes. Findings empower collaborations between pharmacists and stakeholders to identify and overcome contribution barriers. Strategies to mitigate barriers and enhance sepsis contributions were envisaged by reported aspirations. These emphasised the importance of professional advocacy, interprofessional education and impactful implementation research.

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Use of the DMAIC Lean Six Sigma quality improvement framework to improve beta-lactam antibiotic adequacy in the critically ill

Wessel,

Rivera,

Ausman

et al. 2024

International Journal for Quality in Health Care

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Background: Beta-lactam antibiotics are widely used in the intensive care unit due to their favorable effectiveness and safety profiles. Beta-lactams given to patients with sepsis must be delivered as soon as possible after infection recognition (early), treat the suspected organism (appropriate), and at a dose that eradicates the infection (adequate). Early and appropriate antibiotic delivery occurs in >90% of patients, but less than half of patients with sepsis achieve adequate antibiotic exposure. This project aimed to address this quality gap and improve beta-lactam adequacy using the DMAIC Lean Six Sigma quality improvement framework. Methods: A multidisciplinary steering committee was formed and completed a stakeholder analysis to define the gap in practice. An Ishikawa cause and effect (Fishbone) diagram was used to identify the root causes and an impact/effort grid facilitated prioritization of interventions. An intervention which included bundled education with the use of therapeutic drug monitoring (TDM; i.e., drug level testing) was projected to have the highest impact relative to the amount of effort and selected to address beta-lactam inadequacy in the critically ill. Results: The education and TDM intervention were deployed through a Plan, Do, Study, Act (PDSA) cycle. In the three months after ‘go-live,’ 54 episodes of beta-lactam TDM occurred in 41 unique ICU patients. The primary quality metric of beta-lactam adequacy was achieved in 94% of individuals after the intervention. 94% of clinicians gauged the education provided as sufficient. The primary counterbalance of antimicrobial days of therapy, a core antimicrobial stewardship metric, was unchanged over time (favorable result; p=0.73). Conclusions: Application of the DMAIC Lean Six Sigma quality improvement framework effectively improved beta-lactam adequacy in critically ill patients. The approach taken in this quality improvement project is widely generalizable to other drugs, drug classes, or settings to increase the adequacy of drug exposure.

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Why is the Implementation of Beta-Lactam Therapeutic Drug Monitoring for the Critically Ill Falling Short? A Multicenter Mixed-Methods Study

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 5 publications

References 45 publications

Crying Over Stark Differences: Resource Disparity and Therapeutic Drug Monitoring

Crying Over Stark Differences: Resource Disparity and Therapeutic Drug Monitoring

Defining International Critical Care Pharmacist Contributions to Sepsis and Exploring Variability

Use of the DMAIC Lean Six Sigma quality improvement framework to improve beta-lactam antibiotic adequacy in the critically ill

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