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

Background: Therapeutic drug monitoring (TDM) of Vancomycin (VCM) is required to prevent inappropriate dosageassociated 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 diference 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 signifcantly higher in the post-implementation phase, mean diference 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 signifcance, mean diference 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 diference of 0.15, [95% CI (−0.053–0.264), p=0.079]. Conclusion: This study showed the signifcant role of pharmacist-directed TDM services to optimize the correct prescribing of initial VCM doses and dose adjustments.

Background: Therapeutic drug monitoring (TDM) of Vancomycin (VCM) is required to prevent inappropriate dosageassociated 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 diference 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 signifcantly higher in the post-implementation phase, mean diference 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 signifcance, mean diference 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 diference of 0.15, [95% CI (−0.053–0.264), p=0.079]. Conclusion: This study showed the signifcant role of pharmacist-directed TDM services to optimize the correct prescribing of initial VCM doses and dose adjustments.