(1226) Developing and Validating a Dashboard to Optimize Beta-Lactam Therapy in Critically Ill Patients

Introduction: Beta-lactam pharmacokinetics are highly variable in ICU patients, which may compromise effectiveness and safety. Beta-lactam therapeutic drug monitoring (TDM; i.e., drug level testing) has been recommended to improve precision pharmacotherapy. Mayo Clinic launched a beta-lactam TDM program in 2022 for ICU patients. Informatics solutions are needed to monitor the utilization of the beta-lactam TDM program and guide future quality improvement initiatives. This study aimed to develop and validate an electronic health record-based beta-lactam TDM dashboard.

Methods: The beta-lactam TDM Steering Committee queried diverse ICU and antimicrobial stewardship stakeholders to identify desired dashboard metrics. Selected metrics included number of levels performed, effectiveness target attainment (drug level sufficient to treat the infection), and therapeutic range attainment (levels above the effectiveness target and below the toxicity threshold). The dashboard was developed and validated against laboratory system tests (criterion standard). Dashboard completeness and accuracy were evaluated, iterative improvements were implemented, and revalidated. The dashboard was used to describe beta-lactam TDM trends during the first year of the program.

Results: During the first two months of validation, 81 beta-lactam tests were identified in the laboratory system. Of those tests, 79 (98%) transferred to the developed dashboard. The levels which were not found on the dashboard were outside the limits of quantification (one < 0.5 mg/L, one >600 mg/L). All other levels were appropriately labeled as below, within, or above the therapeutic range. The dashboard logic was refined and 35 of 35 (100%) beta-lactam TDM levels during revalidation were identified and categorized correctly. Over the first year, 177 levels were performed (mean ± SD 14 ± 4 levels per month) in the ICU. Therapeutic range attainment across the beta-lactam antibiotics was 75% ± 20%.

Conclusions: The validated beta-lactam TDM dashboard will facilitate ICU and antimicrobial stewardship quality improvement initiatives. Future research could leverage the dashboard to assess the effectiveness of interventions designed to improve target attainment. Similar dashboards could be developed for other medications which routinely undergo TDM in the ICU.