Optimizing vancomycin therapeutic drug monitoring compliance in pediatric oncology: towards personalized medication management

Abstract

Aim: Vancomycin, a crucial treatment for Gram-positive bacteria, necessitates therapeutic drug monitoring (TDM) to prevent treatment failures. We investigated the healthcare professional’s compliance toward TDM of vancomycin recommendations and follow-up levels. Materials & methods: We collected data from 485 patients who received vancomycin in the Children’s Cancer Hospital Egypt 57357 medical records system (Cerner) over 4 months, from January to April 2020. Results: Our data shows that only 54% of patients had TDM requests from healthcare professionals for the total patients who received vancomycin treatment. The healthcare professionals’ compliance with the recommendations was 91.7%, while the follow-up levels were 66.7%. Conclusion: While overall adherence to recommendations is strong, enhancing compliance with follow-up levels remains a priority for improvement.

Article highlights

• Vancomycin therapeutic drug monitoring (TDM) is crucial for effective and safe medication.

• Nearly half of the patients on vancomycin do not get their levels checked.

• Our results show that the healthcare professionals complied with the recommendation guidelines in 91.7% of cases.

• Compliance with the recommendation among total subtherapeutic cases were (90.5%) and among total toxicity cases were (93.8%).

• The compliance rate to follow-up is lower than the recommendations, with 66.7% compliance compared with 33.3% noncompliance.

• Our comprehensive approach has resulted in over 90% compliance rates. The hospital’s electronic system (Cerner) also provides helpful pop-up alerts and reminders to support the TDM process.

• We recommend establishing TDM-focused educational programs such as a pharmacist-led TDM credentialing program, facilitating access to decision-support tools and adopting a multidisciplinary team approach, which can improve communication among healthcare professionals.

Keywords: :

• healthcare team compliance
• pediatric oncology
• personalized medication management
• personalized medicine
• precision medicine
• TDM recommendations
• vancomycin

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Institutional review board statement

CCHE’s Human Research Ethics Committee granted ethics approval for this project.

Data availability statement

The data represented in this article are available on request from the corresponding author.