Still Haven’t Made the Switch to Area Under the Curve Dosing for Vancomycin? Now’s the Time to Consider PINC AI™ Clinical Surveillance

Key takeaways:

• Bayesian software programs are the preferred methodology for area under the curve (AUC) vancomycin dosing to prevent acute kidney injury (AKI).
• Many hospitals haven’t fully implemented AUC dosing due to challenges caused by the COVID-19 pandemic, cost concerns and a variety of other factors.
• Pharmacy departments can improve efficiency and safety with InsightRX’s Bayesian dosing software integrated with PINC AI™ clinical surveillance software powered by TheraDoc®.

Hospitalized patients are often treated with antibiotics. Although antibiotics can be lifesaving in treating infection, suboptimal dosing may be linked to serious harm. Vancomycin, which is often used to treat a variety of infections, is a good illustration of this point. Insufficient vancomycin exposure can lead to treatment failure, while excessive vancomycin exposure can lead to acute kidney injury (AKI), with the potential for lasting kidney damage. Moreover, these events can result in longer lengths of stay, higher costs and higher mortality rates.

A core tenant of antimicrobial stewardship is giving the right drug at the right time and at the right dose. Therapeutic drug monitoring (TDM) of vancomycin is essential to ensure that the right dose is given and to maximize efficacy, limit toxicity and minimize antimicrobial resistance. Recommendations on how to dose and monitor vancomycin have evolved over time. The newest guidelines for vancomycin TDM recommend area under the curve (AUC)-based vancomycin dosing in place of traditional trough-based dosing for various patient populations.

The Bayesian methodology is the preferred approach for vancomycin monitoring, as it enables clinicians to estimate vancomycin AUC values more precisely than with manual calculations. However, many pharmacy departments haven’t yet fully implemented these guidelines (in some cases due to technical and resource challenges resulting from the COVID-19 pandemic), making it difficult for clinicians to provide high-quality patient care.

In fact, studies suggest a baseline rate of AKIs of 16.4 percent on average for patients receiving vancomycin. Quickly adopting Bayesian model solutions helps put the patient back at the top of a clinician’s priority list.

What is Bayesian dosing?

The Bayesian methodology uses patient data and laboratory results to predict a patient's vancomycin exposure. The Bayesian approach looks at past data on how patients across a population have responded to a medication to aid clinicians in anticipating how a specific patient might respond to the drug. This information is then used to provide a patient-specific dosing recommendation.

The Bayesian approach has been shown to improve dosing accuracy and reduce toxicity without compromising efficacy. Plus, this methodology can be based on a single blood drug level that can be drawn at any time between doses. This reduces the operational burden on clinicians because, unlike the manual AUC-based methods, it doesn’t require blood concentrations to be measured precisely at peak and trough time points.

Optimize Your Pharmacy Workflow with PINC AI™ Integrated Solutions

The Bayesian methodology does require complex calculations that could be time consuming. By employing clinical decision support (CDS) software to carry out the computations, clinicians can swiftly determine the ideal dosing for each patient.

And that’s where Premier and our PINC AI™ technology suite come in. In order to streamline the implementation of the vancomycin guidelines, Premier partnered with InsightRX to integrate the Bayesian dosing technology with the PINC AI™ clinical surveillance technology, TheraDoc. This integration allows users to perform AUC dosing seamlessly and rapidly for vancomycin as part of their workflow.

The Cost-Effectiveness of Bayesian Dosing

In addition to competing projects and initiatives, department and executive leadership need to justify budgetary allocation for any improvement initiative such as a Bayesian model platform. Bayesian dosing software is sometimes viewed as a more expensive option for AUC dosing needs. Yet typical return on investment (ROI) assessments put Bayesian far ahead of other AUC dosing methodologies in returns, ensuring that long-term financial success is guaranteed versus short-term cost cutting.

Recent studies show that integrated Bayesian solutions can reduce pharmacist time spent dosing and monitoring vancomycin patients. And, when paired with training and onboarding by actual clinicians, pharmacy departments can rest at ease knowing their staff is taken care of by experts in the field.

Facilities leveraging an integrated software solution for AUC dosing such as InsightRX integrated with TheraDoc can decrease time spent on vancomycin, cut operational and staffing costs, and help to reduce adverse events. Ultimately, that means less time spent on managing vancomycin and more time putting the patient back into focus with other pharmacy initiatives.

Learn more about the PINC AI™ clinical surveillance solution and services.

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