Technology
Pharmacy Practice News • October 2020
19
Infectious Disease
Technology Can Help With Vancomycin Dosing H
ouston Methodist Hospital (HMH) is leading a shift this September toward AUC (area under the curve) vancomycin dosing in all eight facilities of the Houston Methodist health system, said William L. Musick, PharmD, BCIDP, a clinical specialist in infectious diseases at HMH’s 1,200-bed flagship location. “We knew for almost two years this would be the direction of the new vancomycin guidelines, and the direction we had to move,” Dr. Musick said. Still, to validate this dosing strategy, HMH analyzed target blood attainment levels and patient safety data of approximately 3,500 courses of vancomycin administered in 2018 and 2019, roughly one-third via the newer AUC approach and two-thirds by the traditional trough level–guided method. “We [achieved] a 30% relative reduction in AKI [acute kidney injury] events and a 20% relative reduction in the likelihood of abnormally high or low vancomycin trough levels when guided
by AUC,” said Dr. Musick, citing the yearlong research and quality project largely done by Joshua Knight, PharmD, a pharmacy infectious diseases resident at HMH. HMH’s AUC study predated the new vancomycin guidelines issued in March 2020 by ASHP, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists (Am J Health Syst Pharm 2020;77[11]:835864; bit.ly/3hIFl0c).
Software Help To help make the AUC shift more effective, the health system has become an early adopter of integrated software—VigiLanz precision dosing powered by Tabula Rasa Healthcare’s DoseMeRx—to handle the complex calculations of the AUC approach. This integrated software became available in April 2020, after the HMH analysis. “Knowing that AUC leads to more favorable outcomes, it has to be our
‘Knowing that AUC leads to more favorable outcomes, it has to be our primary method for making dosing decisions. This integrated software eliminates hurdles of complicated math I can’t ask my pharmacists to do.’ —William L. Musick, PharmD
primary method for making dosing decisions. This integrated software eliminates hurdles of complicated math I can’t ask my pharmacists to do,” said Dr. Musick, who heads a team of five infectious disease pharmacists. HMH has used VigiLanz to aggregate data on antimicrobial usage, dosing and microbiology, and to alert pharmacists about potential antibiotic stewardship issues requiring intervention for the past decade; it has used DoseMeRx to optimize patient-specific dosing for the past five years. Both ran as stand-alone software products, but DoseMeRx will now operate within the VigiLanz platform, which sits atop HMH’s Epic pharmacy management system and Epic electronic health and medication administration records systems, Dr. Musick noted. This means that patient-specific demographics, laboratory results, medication orders and antibiotic doses administered populate DoseMeRx fields so the software can quickly calculate optimal dosing for adult and pediatric patients. “This expedites dose changes as needed, eliminates the possibility
of data entry errors by end users, and saves a lot of labor time. I think we’ll see better patient outcomes,” he added. The software is cloud-based, accessible to pharmacists via browser, and issues patient-specific alerts by emails and pagers.
COVID-19 Drives Need For Efficiency The COVID-19 pandemic increased the need for streamlining vancomycin dosing, Dr. Musick noted. The infectious diseases pharmacy team at HMH “easily faced a 25% increase in patients monitored daily on antibiotics, plus the additional workload on investigational agents for COVID-19 because we’re involved in the day-to-day maintenance and screening of all patients in clinical trials for potentially new COVID medications,” he explained in mid-August, when Houston was a hot spot and HMH was caring for between 160 and 170 COVID-19 inpatients. The added COVID-19 workload made it “quite timely for us getting to speed on this technology, though combining see VANCOMYCIN, page 20
