Abstract
Many hospitals face barriers in the implementation of TDM services, this study aimed to evaluate a pharmacist-led TDM service to optimize patients’ outcomes. Adult patients who were administered vancomycin, gentamicin, or amikacin were included. The pre-phase included a retrospective assessment of patients and the intervention phase consisted of an educational program. The post-phase assessed patients based on TDM services provided by inpatient pharmacists on a 24-h, 7-day basis for 3 months. The primary outcome was to assess the mean difference in proportion of correct initial doses of prescribing orders. Secondary outcomes included assessing the mean differences in proportions of correct dose adjustments and correct drug sampling time. Seventy-five patients in each phase were eligible. Patients who received optimal initial dosing in the post-phase showed a higher statistical significance, mean difference of 0.31, [95% CI (0.181–0.4438), p < 0.0001]. Patients in the post-phase received more optimal dose adjustments, mean difference of 0.1, [95% CI (−0.560–0.260), p = 0.2113]. Drug levels were ordered more correctly in the post-phase, mean difference of 0.03, [95% CI (−0.129–0.189), p = 0.7110]. This study demonstrated the important role of TDM services led by pharmacists in optimizing the initial dosing for these antibiotics.
Highlights
Therapeutic drug monitoring is a fundamental responsibility of pharmacists to provide optimum therapeutic outcomes for patients [1]
The aim of this study was to evaluate the impact of an inpatient pharmacist-led service to improve therapeutic drug monitoring of antibiotics and to fill-in the gaps by enhancing pharmacist training regarding Therapeutic drug monitoring (TDM), and providing 24-h services on a daily basis focusing on vancomycin and aminoglycosides with the goal of optimizing patient care at our institution
Our study shows a higher proportion of patients who received the correct initial dosing, correct dose adjustments and were ordered correct drug levels after the implementation of a pharmacist-led TDM service, our findings are consistent with
Summary
Therapeutic drug monitoring is a fundamental responsibility of pharmacists to provide optimum therapeutic outcomes for patients [1]. Pharmacist-led TDM services have demonstrated positive outcomes which include decreased incidence of adverse effects of drug therapy, reduced length of treatment, reduced length of hospital stay, decreased morbidity, decreased mortality, and cost-savings [1,2,3,4,5,6,7]. Evidence has demonstrated the benefits of these pharmaceutical services, many healthcare settings have not been able to optimally utilize the knowledge and skills of inpatient pharmacists to provide advanced patient-centered services [4,10]. In a recent study done by Kheir et al (2015), barriers for providing TDM services have been identified, which include pharmacists spending most of their
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