Blood, dose recommendation reports and phone calls - Experiences of a Therapeutic Drug Monitoring Advisory Service for vancomycin.

Dose-prediction software is recommended to enable area under the curve over 24 hours (AUC 24 )-guided dosing of the antibiotic, vancomycin. However, uncertainty remains about how best to implement software in the clinic. We describe the activity, over 18-months, of a consultative therapeutic drug monitoring (TDM) Advisory Service (the Service) for vancomycin that used dose-prediction software alongside clinical expertise, identifying factors that influence attainment of therapeutic targets. Of the 408 vancomycin dose reports provided for 182 courses of therapy, most (57%) recommended a dose change. The majority (82.8%, 193/233) of recommended dose adjustments were accepted by treating teams. A dose report wasn't published for 125 courses of therapy, reasons included patient in ICU or Service error. An estimated 26.6h of staff time was allocated to Service activities each month. Publication of a dose report facilitated attainment of therapeutic targets (p=0.002). Software integration could improve Service outcomes, avoiding errors and reducing staff workload.