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

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.