852: IMPROVING KNOWLEDGE AND CONFIDENCE WITH BETA-LACTAM THERAPEUTIC DRUG MONITORING IN THE ICU

Abstract

Introduction: Beta-lactam antibiotics are the backbone of sepsis treatment, but a ‘one-size-fits-all’ dosing strategy leads to unpredictable effects. Therapeutic drug monitoring (TDM; i.e., drug level testing) can personalize treatment and improve outcomes. Pharmacists are the key operational stakeholders for beta-lactam TDM in the ICU, but evidence suggests they have low knowledge and confidence with the practice. We hypothesized that delivery of bundled education intervention would increase pharmacist knowledge and confidence about beta-lactam TDM without jeopardizing the proportion that feel such a program is worthwhile. Methods: A questionnaire was developed and distributed to critical care and infectious diseases pharmacists at a large academic medical center before and after delivery of a bundled educational intervention on beta-lactam TDM. Component parts of the education included a web-based asynchronous learning module on beta-lactam TDM, an electronically available pharmacokinetic calculator, infographics of key content and workflow processes, a frequently asked questions document, and practice champion training. Questionnaire items were based on the ADKAR framework (awareness, desire, knowledge, ability, and reinforcement). Results were summarized descriptively and the Chi-square test was used for two-way binary comparisons. Results: Of 66 available pharmacists, 55 (83%) and 35 (53%) responded to the baseline and follow-up (after the educational intervention) questionnaires. Significantly more respondents felt comfortable recommending beta-lactam TDM for infected critically ill patients after the educational intervention (29% vs 97%; P < 0.001). Familiarity with operational considerations were similarly improved including with patient selection, number and timing of samples, and application of results. The proportion of respondents who felt beta-lactam TDM was worthwhile increased from 60% to 80% after education (P = 0.002). Conclusions: A bundled education intervention can increase knowledge, comfortability, and confidence with beta-lactam TDM in the critically ill among pharmacists, the key operational stakeholders.