Ausman Sara E, Moreland-Head Lindsay N, Abu Saleh Omar M, Jannetto Paul J, Rivera Christina G, Stevens Ryan W, Wessel Rebecca J, Wieruszewski Patrick M, Barreto Erin F
Department of Pharmacy, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.
J Am Coll Clin Pharm. 2023 Aug;6(8):964-975. doi: 10.1002/jac5.1819. Epub 2023 May 29.
Beta-lactam therapeutic drug monitoring (TDM) can improve precision dosing and clinical outcomes in critically ill patients, but has not been implemented widely in the United States. Mayo Clinic recently implemented a beta-lactam TDM program. This single-center experience forms the basis of the manuscript which outlines practical considerations involved with implementation, including the pharmacist's role as a leader. Our implementation effort focused on three primary domains. First, we aimed to ensure a supportive organizational infrastructure. Early leadership engagement by the pharmacist-led core team facilitated advocacy for the clinical need, allocation of resources, and assay development. Second, core clinical workflows were developed that addressed the preferred patient population for use, desirable pharmacokinetic and pharmacodynamic targets, and the preferred sampling strategy. Clinical tools to guide pharmacists in interpreting the results (e.g., pharmacokinetics calculator) and documenting decisions were developed. Third, stakeholders were offered repeated exposure to evidence and expertise to facilitate understanding and application of the new practice. This act of 'individual internalization' seems to be uniquely important to beta-lactam TDM implementation compared with implementation of other antimicrobial TDM programs. Educational strategies and supportive materials that were developed were focused on providing substantive and varied information tailored to the stakeholders' role in the process. For pharmacists, this included both clinical and operational considerations. A continuous improvement plan to support management of the process was instituted to address necessary updates and changes that inevitably emerged. In summary, the described approach to implementation of a pharmacist led beta-lactam TDM program could be used as a roadmap to aid other institutions that aim to develop such a program.
β-内酰胺类治疗药物监测（TDM）可提高重症患者的精准给药水平及临床疗效，但在美国尚未得到广泛应用。梅奥诊所近期实施了一项β-内酰胺类TDM计划。这一单中心经验构成了本文的基础，本文概述了实施过程中涉及的实际考量因素，包括药剂师作为领导者的角色。我们的实施工作聚焦于三个主要领域。首先，我们旨在确保有一个支持性的组织架构。由药剂师主导的核心团队早期与领导层的接触，有助于为临床需求争取支持、资源分配以及检测方法的开发。其次，制定了核心临床工作流程，明确了适用的首选患者群体、理想的药代动力学和药效学目标以及首选的采样策略。开发了指导药剂师解读结果（如药代动力学计算器）和记录决策的临床工具。第三，让利益相关者反复接触相关证据和专业知识，以促进对新实践的理解和应用。与其他抗菌药物TDM计划的实施相比，这种“个体内化”行为似乎对β-内酰胺类TDM的实施尤为重要。所制定的教育策略和支持材料侧重于提供针对利益相关者在该过程中角色的实质性且多样的信息。对于药剂师而言，这包括临床和操作方面的考量。制定了一项支持该流程管理的持续改进计划，以应对不可避免出现的必要更新和变化。总之，所描述的由药剂师主导的β-内酰胺类TDM计划的实施方法，可作为帮助其他旨在开展此类计划的机构的路线图。
