Sitting around the house all week with a nasty head cold and not feeling like doing anything physical gave me the opportunity to work on some things that I have put off for too long.
For any number of reasons the default population model may not fit a particular patient. If your patient has a documented history of vancomycin serum level analysis, you should use it. For new starts on patients with a history I usually click the retrospective tab to determine their model parameters. But, it has been on my TODO list for sometime to have this history available on the prospective tab. So this week I finally found the time to add a “Retrieve” button to the prospective tab.
If the patient has a history of serum level analysis, the “Retrieve” button is active, otherwise it is dithered out.
When the “Retrieve” button is active, click to select the most recent consult, regardless of drug. If you want to narrow your search to a specific drug, select a model first then click. The retrieve function will fill in the model parameters with the most recently calculated patient specific model. The date when that historical model was calculated is also displayed.
Hover the mouse anywhere over the ‘Edit model parameters’ frame to display more details about the historical model (weight, CrCl, measured trough, Kel, and Vd).
Click the “Restore” button to switch to the population model. You can use the “Retrieve” and “Restore” buttons to toggle back and forth between population and historical models for comparison.
If you decide to use the historical model the consult print-out will show that a historical model was used and the date from which it was pulled.
On the retrospective side I’ve added the option to choose the base model for Bayesian analysis. You can either use the population model or the historical model. Again, the date and details of the most recent analysis is displayed. Use this information to determine whether the patient history is applicable to the current situation.
Similar to prospective, you can use this dialog to toggle back and forth between population and historical models for comparison.
Also new, after you close the Bayesian results dialog you will see this informational dialog.
As the dialog states, the details of the Bayesian results have been automatically copied to the Windows clipboard. You can then use the Windows shortcut Ctrl+V to paste this information into your EMR consult or wherever you want to save it to.
My two cents
Of course, all of this, everything I have discussed above, depends on your fellow pharmacists following through, completing the job.
I harp on this all the time. If the level comes back within target range, don’t just write it down and go on, enter the level(s) and save the analysis!
So many opportunities are lost when someone doesn’t follow through. Not only with patient specific analysis as detailed above, but also with the population analysis tool (which I have discussed numerous times on this blog).