Therapeutic Drug Monitoring of Vancomycin Based on Ratio of Area under the Curve to Minimum Inhibitory Concentration: A Quality Improvement Project.

BACKGROUND: Various organizations recommend targeting a calculated ratio of area under the curve to minimum inhibitory concentration (AUC/MIC) of 400-600 for therapeutic drug monitoring (TDM) of vancomycin. Sites that have implemented AUC/MIC-based TDM for vancomycin have shown reduced vancomycin exposure, decreased nephrotoxicity rates, and fewer dosage adjustments relative to the use of trough monitoring. OBJECTIVES: To implement AUC/MIC-based TDM for vancomycin at a pediatric and obstetric tertiary care site and to assess pharmacists' knowledge and satisfaction before and 1 month after implementation and at 2-year follow-up. METHODS: This quality improvement project involved the planning, implementation, and evaluation of AUC/MIC-based TDM for vancomycin. Anonymous electronic surveys were distributed to pharmacists before and after implementation and at 2-year follow-up, assessing practices, comfort, knowledge, and satisfaction with AUC/MIC-based TDM. RESULTS: Implementation of AUC/MIC-based TDM for vancomycin occurred in April 2021, after 8 months of preparation during which educational sessions, a dosing calculator, guidelines, and written communications were developed and delivered. Surveys were partially or fully completed by 27 pharmacists before implementation, by 24 pharmacists at 1 month after implementation, and by 32 pharmacists at 2-year follow-up. At 1 month and 2 years after implementation, larger proportions of respondents felt knowledgeable (88% [n = 21] and 81% [n = 26], respectively, vs 22% [n = 6] before implementation) and comfortable (88% [n = 21] and 81% [n = 26], respectively, vs 19% [n = 5] before implementation) with AUC/MIC-based TDM. Respondents' satisfaction with implementation of AUC/MIC-based TDM was 88% (n = 21/24) at 1 month after implementation and 94% (n = 29/31) at the 2-year follow-up. CONCLUSIONS: AUC/MIC-based TDM for vancomycin was implemented with high pharmacist satisfaction. Future studies at this site should investigate clinical outcomes.