Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital
BackgroundModel-informed precision dosing (MIPD) can serve as a powerful tool during therapeutic drug monitoring (TDM) to help individualize dosing in populations with large pharmacokinetic variation. Yet, adoption of MIPD in the clinical setting has been limited. Overcoming technologic hurdles that...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2020-04-01
|
| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fphar.2020.00551/full |
| _version_ | 1811286033514364928 |
|---|---|
| author | Adam Frymoyer Hayden T. Schwenk Yvonne Zorn Laura Bio Jeffrey D. Moss Bhavin Chasmawala Joshua Faulkenberry Srijib Goswami Ron J. Keizer Shabnam Ghaskari |
| author_facet | Adam Frymoyer Hayden T. Schwenk Yvonne Zorn Laura Bio Jeffrey D. Moss Bhavin Chasmawala Joshua Faulkenberry Srijib Goswami Ron J. Keizer Shabnam Ghaskari |
| author_sort | Adam Frymoyer |
| collection | DOAJ |
| description | BackgroundModel-informed precision dosing (MIPD) can serve as a powerful tool during therapeutic drug monitoring (TDM) to help individualize dosing in populations with large pharmacokinetic variation. Yet, adoption of MIPD in the clinical setting has been limited. Overcoming technologic hurdles that allow access to MIPD at the point-of-care and placing it in the hands of clinical specialists focused on medication dosing may encourage adoption.ObjectiveTo describe the hospital implementation and usage of a MIPD clinical decision support (CDS) tool for vancomycin in a pediatric population.MethodsWithin an academic children’s hospital, MIPD for vancomycin was implemented via a commercial cloud-based CDS tool that utilized Bayesian forecasting. Clinical pharmacists were recognized as local champions to facilitate adoption of the tool and operated as end-users. Integration within the electronic health record (EHR) and automatic transmission of patient data to the tool were identified as important requirements. A web-link icon was developed within the EHR which when clicked sends users and needed patient-level clinical data to the CDS platform. Individualized pharmacokinetic predictions and exposure metrics for vancomycin are then presented in the form of a web-based dashboard. Use of the CDS tool as part of TDM was tracked and users were surveyed on their experience.ResultsAfter a successful pilot phase in the neonatal intensive care unit, implementation of MIPD was expanded to the pediatric intensive care unit, followed by availability to the entire hospital. During the first 2+ years since implementation, a total of 853 patient-courses (n = 96 neonates, n = 757 children) and 2,148 TDM levels were evaluated using the CDS tool. For the most recent 6 months, the CDS tool was utilized to support 79% (181/230) of patient-courses in which TDM was performed. Of 26 users surveyed, > 96% agreed or strongly agreed that automatic transmission of patient data to the tool was a feature that helped them complete tasks more efficiently; 81% agreed or strongly agreed that they were satisfied with the CDS tool.ConclusionsIntegration of a vancomycin CDS tool within the EHR, along with leveraging the expertise of clinical pharmacists, allowed for successful adoption of MIPD in clinical care. |
| first_indexed | 2024-04-13T02:53:38Z |
| format | Article |
| id | doaj.art-ef886d4cf4034249bfe305e0b6882dda |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-13T02:53:38Z |
| publishDate | 2020-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-ef886d4cf4034249bfe305e0b6882dda2022-12-22T03:05:46ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122020-04-011110.3389/fphar.2020.00551523256Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s HospitalAdam Frymoyer0Hayden T. Schwenk1Yvonne Zorn2Laura Bio3Jeffrey D. Moss4Bhavin Chasmawala5Joshua Faulkenberry6Srijib Goswami7Ron J. Keizer8Shabnam Ghaskari9Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United StatesDepartment of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United StatesDepartment of Clinical Pharmacy, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, United StatesDepartment of Clinical Pharmacy, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, United StatesDepartment of Clinical Pharmacy, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, United StatesInformation Services, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, United StatesInformation Services, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, United StatesInsightRx, San Francisco, CA, United StatesInsightRx, San Francisco, CA, United StatesInformation Services, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, United StatesBackgroundModel-informed precision dosing (MIPD) can serve as a powerful tool during therapeutic drug monitoring (TDM) to help individualize dosing in populations with large pharmacokinetic variation. Yet, adoption of MIPD in the clinical setting has been limited. Overcoming technologic hurdles that allow access to MIPD at the point-of-care and placing it in the hands of clinical specialists focused on medication dosing may encourage adoption.ObjectiveTo describe the hospital implementation and usage of a MIPD clinical decision support (CDS) tool for vancomycin in a pediatric population.MethodsWithin an academic children’s hospital, MIPD for vancomycin was implemented via a commercial cloud-based CDS tool that utilized Bayesian forecasting. Clinical pharmacists were recognized as local champions to facilitate adoption of the tool and operated as end-users. Integration within the electronic health record (EHR) and automatic transmission of patient data to the tool were identified as important requirements. A web-link icon was developed within the EHR which when clicked sends users and needed patient-level clinical data to the CDS platform. Individualized pharmacokinetic predictions and exposure metrics for vancomycin are then presented in the form of a web-based dashboard. Use of the CDS tool as part of TDM was tracked and users were surveyed on their experience.ResultsAfter a successful pilot phase in the neonatal intensive care unit, implementation of MIPD was expanded to the pediatric intensive care unit, followed by availability to the entire hospital. During the first 2+ years since implementation, a total of 853 patient-courses (n = 96 neonates, n = 757 children) and 2,148 TDM levels were evaluated using the CDS tool. For the most recent 6 months, the CDS tool was utilized to support 79% (181/230) of patient-courses in which TDM was performed. Of 26 users surveyed, > 96% agreed or strongly agreed that automatic transmission of patient data to the tool was a feature that helped them complete tasks more efficiently; 81% agreed or strongly agreed that they were satisfied with the CDS tool.ConclusionsIntegration of a vancomycin CDS tool within the EHR, along with leveraging the expertise of clinical pharmacists, allowed for successful adoption of MIPD in clinical care.https://www.frontiersin.org/article/10.3389/fphar.2020.00551/fullvancomycinchildrenpharmacokineticsclinical decision supporttherapeutic drug monitoring |
| spellingShingle | Adam Frymoyer Hayden T. Schwenk Yvonne Zorn Laura Bio Jeffrey D. Moss Bhavin Chasmawala Joshua Faulkenberry Srijib Goswami Ron J. Keizer Shabnam Ghaskari Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital Frontiers in Pharmacology vancomycin children pharmacokinetics clinical decision support therapeutic drug monitoring |
| title | Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital |
| title_full | Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital |
| title_fullStr | Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital |
| title_full_unstemmed | Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital |
| title_short | Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital |
| title_sort | model informed precision dosing of vancomycin in hospitalized children implementation and adoption at an academic children s hospital |
| topic | vancomycin children pharmacokinetics clinical decision support therapeutic drug monitoring |
| url | https://www.frontiersin.org/article/10.3389/fphar.2020.00551/full |
| work_keys_str_mv | AT adamfrymoyer modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT haydentschwenk modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT yvonnezorn modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT laurabio modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT jeffreydmoss modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT bhavinchasmawala modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT joshuafaulkenberry modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT srijibgoswami modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT ronjkeizer modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital AT shabnamghaskari modelinformedprecisiondosingofvancomycininhospitalizedchildrenimplementationandadoptionatanacademicchildrenshospital |