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Model-informed precision dosing of vancomycin in clinical practice: an intervention development study.

Maria Swartling1, Anna-Karin Hamberg2, Mia Furebring3

  • 1Department of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden.

International Journal of Clinical Pharmacy
|November 8, 2024
PubMed
Summary

This study developed a model-informed precision dosing (MIPD) workflow for vancomycin AUC-guided dosing to improve clinical practice. The intervention includes a standardized process and implementation plan for better vancomycin therapy.

Keywords:
Health plan implementationPrecision dosingPrecision medicineTherapeutic drug monitoringVancomycin

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Area of Science:

  • Pharmacokinetics and Pharmacodynamics
  • Clinical Pharmacy Practice
  • Health Services Research

Background:

  • Current guidelines advocate vancomycin dosing based on area under the concentration-time curve (AUC) to optimize efficacy and reduce nephrotoxicity.
  • Model-informed precision dosing (MIPD) is the preferred method for AUC-guided vancomycin therapy, but its clinical adoption remains limited.

Purpose of the Study:

  • To develop a standardized MIPD workflow and implementation plan for vancomycin AUC-guided dosing.
  • To facilitate the adoption of MIPD in a Swedish tertiary hospital setting.

Main Methods:

  • A framework-guided development process incorporating stakeholder feedback (nurses, pharmacists, physicians).
  • Local data collection, feasibility testing of intervention components, and consideration of implementation strategies.
  • Development of a logic model to represent the intervention's hypothesized relationships and outcomes.

Main Results:

  • A comprehensive MIPD workflow was created, defining roles, responsibilities, and data/information transfer processes.
  • Supportive documents were developed, including instructions for therapeutic drug monitoring (TDM) sampling and dosing software.
  • Implementation activities included establishing local clinical routines, staff training, and regular MIPD rounds.

Conclusions:

  • An intervention package for MIPD, including an implementation plan for vancomycin AUC-guided dosing, was successfully developed for a tertiary hospital.
  • The developed process can serve as a guide for other institutions seeking to implement MIPD.