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 im...

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Autores principales:	Kashif Hussain, Rahila Ikram, Gul Ambreen, Muhammad Sohail Salat
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Therapeutic Drug Monitoring Pharmacist Vancomycin Pediatric TDM Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/d8a77add683043fc942fb818ac2a6fe7
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spelling	oai:doaj.org-article:d8a77add683043fc942fb818ac2a6fe72021-12-05T12:04:01ZPharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model10.1186/s40545-021-00383-y2052-3211https://doaj.org/article/d8a77add683043fc942fb818ac2a6fe72021-11-01T00:00:00Zhttps://doi.org/10.1186/s40545-021-00383-yhttps://doaj.org/toc/2052-3211Abstract 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.Kashif HussainRahila IkramGul AmbreenMuhammad Sohail SalatBMCarticleTherapeutic Drug MonitoringPharmacistVancomycinPediatricTDMTherapeutics. PharmacologyRM1-950Pharmacy and materia medicaRS1-441ENJournal of Pharmaceutical Policy and Practice, Vol 14, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutic Drug Monitoring Pharmacist Vancomycin Pediatric TDM Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
spellingShingle	Therapeutic Drug Monitoring Pharmacist Vancomycin Pediatric TDM Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441 Kashif Hussain Rahila Ikram Gul Ambreen Muhammad Sohail Salat Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
description	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.
format	article
author	Kashif Hussain Rahila Ikram Gul Ambreen Muhammad Sohail Salat
author_facet	Kashif Hussain Rahila Ikram Gul Ambreen Muhammad Sohail Salat
author_sort	Kashif Hussain
title	Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
title_short	Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
title_full	Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
title_fullStr	Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
title_full_unstemmed	Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
title_sort	pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d8a77add683043fc942fb818ac2a6fe7
work_keys_str_mv	AT kashifhussain pharmacistdirectedvancomycintherapeuticdrugmonitoringinpediatricpatientsacollaborativepracticemodel AT rahilaikram pharmacistdirectedvancomycintherapeuticdrugmonitoringinpediatricpatientsacollaborativepracticemodel AT gulambreen pharmacistdirectedvancomycintherapeuticdrugmonitoringinpediatricpatientsacollaborativepracticemodel AT muhammadsohailsalat pharmacistdirectedvancomycintherapeuticdrugmonitoringinpediatricpatientsacollaborativepracticemodel
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Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model

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