Dosing and monitoring of vancomycin can be complex, requiring clinicians to take many considerations into account including patient-specific factors that influence pharmacokinetics and pharmacodynamics. Traditionally, calculating precise vancomycin doses for patients requires coordination among pharmacists, nurses, and laboratory technicians as well as manual data entry and calculations that is time-consuming and prone to errors.
Area under the curve (AUC) calculation can be accomplished using either a Bayesian dosing software or a formula-based approach, such as the trapezoidal model. Manual AUC calculation is cumbersome and time-consuming, as it requires more computing efforts and pharmacokinetic sampling (at least two serum levels). The Bayesian approach is the preferred method to estimate AUC, as it provides several advantages compared to traditional PK calculation.
Bayesian dosing (also known as precision dosing) uses patient data and laboratory results to estimate a patient's ability to absorb, process, and clear a drug from their system. Using a clinically validated population model, algorithms adjust the pharmacokinetic and/or pharmacodynamic parameters so that a patient-specific, individualized drug model is built. This individual model is then used to provide a patient-specific dosing recommendation to reach a therapeutic target.
Clinical surveillance solutions, integrated with Bayesian dosing calculators, can facilitate this change by performing the complex Bayesian calculations that aid in the optimal dosing recommendation for each patient by seamlessly pulling existing patient data. Here, we will review key benefits of integrating a Bayesian dosing calculator into a clinical decision support tool.
1. Single, centralized workflow
The first key benefit of an integrated solution is a single, centralized workflow. With a single click, review patient-specific parenteral vancomycin dose recommendations calculated automatically using key clinical data such as patient weight, laboratory values, creatinine levels and medication administration times, pulled directly from Sentri7® Pharmacy. Access faster, more precise calculations to proactively monitor for adjustments and reduce a patient’s risk of acute kidney injury (AKI). Seamlessly flow from an alert to the dosing and then the metrics to assess and evaluate your Antimicrobial Use.
2. Evidence-based rules and alerting
With a real-time vancomycin dosing calculator integrated into your clinical surveillance solution, your team can leverage evidence-based AMS rules to assess appropriate vancomycin use and keep prescribing in line with your hospital’s antimicrobial stewardship goals and the CDC’s Core Elements. For example, an alert may be set up to notify pharmacists of patients whose cultures indication methicillin-resistant Staphylococcus aureus infection. With Sentri7’s integrated Bayesian dosing software, the pharmacist can navigate quickly from alert to dose determination with one click, getting the patient on the right antibiotics as quickly as possible. Pharmacists can also set up alerts to identify patients whose vancomycin level have resulted from the laboratory, to facilitate dose recalculation based on patient’s own individualized clearance.
3. Seamless data transfer to AUC calculation
An integrated solution allows for seamless data transfer to populate AUC calculation – eliminating the need for a pharmacist to enter any data. Patient's demographics such as height, weight, and laboratory results are automatically populated, saving the pharmacist time on data entry, and eliminating potential patient risks due to data entry errors.
4. Documenting interventions
Using Sentri7’s intervention documentation tool, pharmacists can capture the dosing service provided and leave any important notes for other pharmacists to ensure seamless transfer of information in a variety of pharmacy practice models. Pharmacy leaders can generate reports to demonstrate the value of clinical pharmacists in improving vancomycin dosing in their organizations.
5. Patient tracking dashboard
Sentri7’s user-friendly dashboard provides a centralized place to assess and evaluate all patients on parenteral vancomycin therapy in the hospital. The dashboard can be customized to display important clinical parameters such as creatinine, creatinine clearance, white blood cell counts, temperature, and vancomycin levels that enable pharmacists to quickly prioritize their vancomycin dosing workflow.
6. Analytics: alert response, duration of therapy, usage metrics (DOT), NHSN benchmarking
Robust analytics are essential to help antimicrobial stewardship leaders gather relevant data to assess the effectiveness of their programs. Sentri7’s analytics platform provides key process metrics such as alert response rate, time, and interventions data to determine adherence to clinical programs. Outcomes data presented as vancomycin Days of Therapy (DOT), duration of therapy, and NHSN benchmarking Standardized Antimicrobial Administration Ratios (SAAR) help hospitals understand if vancomycin usage is within expected range based on the hospital’s characteristics. This component complements Bayesian dosing to ensure that your antimicrobial stewardship program focus on both the right dosing AND using the right drugs.
Using DoseMeRx integrated with Sentri7 provides an easy path to implement ASHP’s 2020 recommendation for Bayesian-guided dosing and monitoring vancomycin. By taking this data-driven approach to dose optimization, you are able to standardize patient care and increase the proportion of patients in a safe therapeutic range.
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Learn how pharmacy teams are adopting Bayesian dosing tools integrated with clinical surveillance solutions in our on-demand webinar: Vancomycin AUC Dosing From 20 Equations to a Single-Click.
