A standardized system for the entire hospital is required for the rational use of anti-MRSA drugs, and all clinical staff should have a common understanding of it. With this in mind, we introduced a clinical pathway (CP) for anti-MRSA drug TDM analysis, aiming at both standardization and efficiency improvement throughout our hospital. Under the standardized system, initial dosages were set for all anti-MRSA drugs and for all the patients to whom they are administered. Then, after the system had been introduced, we evaluated its influence on treatment efficiency.
The number of requests for initial dosage setting submitted before prescription was only 2.5% without the CP (TDM group) but this increased to 35.0% after the introduction of the CP (TDM-PATH group). Further, mistakes in the timing of blood sampling decreased from 9 cases in the TDM group to 6 cases in the TDM-PATH group and the rate of applying initial dosage settings increased from 10.0% in the TDM group to 22.5% in the TDM-PATH group. In addition, the rate of conducting TDM analysis after setting the initial dosage increased from 55.0% in the TDM group to 72.5% in the TDM-PATH group. There was no instance of not setting initial dosages in the TDM-PATH group. In the first blood sampling, the standard blood concentration for the TDM group was established at 77.3% and at 82.8% for the TDM-PATH group. In the evaluation of the therapeutic effect, the efficiency was 43.5% in the Non-TDM group, 80.0% in the TDM group, and 75.8% in the TDM-PATH group showing a significant improvement both in the TDM group (p<0.01) and in the TDM-PATH group (p<0.001) (χ2-test).
