Evaluating the Impact of a Renal Dosing Refreshable Sidebar Report on Appropriateness of Antimicrobial Dosing at a Large Acute Care Cancer Hospital

Authors

Emily Fox, Providence HealthFollow
Jovan Borjan, The University of Texas MD Anderson Cancer CenterFollow
Nancy Vuong, The University of Texas MD Anderson Cancer CenterFollow
Hannah Aune, The University of Texas MD Anderson Cancer CenterFollow
Claire Marten, The University of Texas MD Anderson Cancer CenterFollow
Joshua Hendrickson, The University of Texas MD Anderson Cancer CenterFollow

Abstract

Background: Appropriate antimicrobial dosing is vital in the treatment of patients with infectious diseases, though adherence to guideline recommended doses is often suboptimal.

Outcomes: This study was conducted to evaluate the impact of a renal dosing refreshable sidebar report, which displayed recommendations from a previously developed institutional antimicrobial dosing guide at the time of antimicrobial order entry. The primary outcome was adherence to daptomycin dosing guideline recommendations before and after implementation.

Methods: This was a pre- and post-quasi-experimental study at a 600-bed acute care cancer hospital. Adult patients (≥18 years old) that received daptomycin from February-April 2021 (pre-intervention phase) and from February-April 2022 (post-intervention phase) were extracted from the EHR. This study was reviewed by the institutional review board and deemed non-human subject research, meeting criteria for exemption from full IRB review.

Results: 150 patients were included in the analysis, 75 in the pre-intervention phase (February-April 2021) and 75 in the post-intervention phase (February-April 2022). Baseline demographics were well-balanced between groups. The most common indications for daptomycin included neutropenic fever (20% and 33% respectively) and SSTI (32% and 44% respectively). Adherence to the recommended dose occurred in 34/75 (45%) patients in the pre-intervention phase and 43/75 (57%) patients in the post-intervention phase (P = 0.12). A statistically significant decrease in mg/kg dosing was observed post-intervention (p=0.03), that resulted in an overall decrease in total mg use of daptomycin.

Conclusion and Relevance: This analysis was the first to demonstrate that implementation of a refreshable report sidebar with renal dosing guidance numerically improved adherence to recommended antimicrobial dosing at a large acute care cancer hospital. This intervention has successfully been expanded to all antimicrobials at our institution.

DOI

https://doi.org/10.52519/ACEQI.25.1.1.a4

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Recommended Citation

Fox E, Borjan J, Vuong N, Aune H, Marten C, Hendrickson J. Evaluating the Impact of a Renal Dosing Refreshable Sidebar Report on Appropriateness of Antimicrobial Dosing at a Large Acute Care Cancer Hospital. Advances in Cancer Education and Quality Improvement. 2025; 1(1). doi: https://doi.org/10.52519/ACEQI.25.1.1.a4.