Do not assume this technology is out of your reach because of limited resources and costs. The value and benefit of model-informed precision dosing software is huge, and it pays for itself rather quickly.
- Kimberly Askren, PharmD at Boone County Hospital
Opportunity
Boone County Hospital, a 25-bed critical access facility serving a rural Iowa community, faced the challenge of managing complex antibiotic therapy with limited staff and resources. Their traditional approach required two timed blood draws and manual PK calculations (both labor-intensive and prone to variability). Compounding the risk, new national consensus guidelines increasingly favored AUC/MIC-based monitoring over trough-based methods, and called for Bayesian modeling to meet evolving standards. For a small hospital, the stakes were high: reduced adverse events, better antibiotic efficacy, and workflow efficiency were critical to patient safety and financial sustainability.
Solution
In May 2019, Boone County adopted the InsightRX Nova precision dosing platform across four high-priority antibiotics, including vancomycin. By integrating patient-specific data and Bayesian forecasting, the software allowed clinicians to calculate individualized dosing from a single scheduled lab draw, replacing the previous two-sample, steady-state manual workflows. InsightRX also provided analytics to track performance against targets and support antimicrobial stewardship mandates.
We evaluated three different Bayesian analytics precision dosing vendors. In the end, we chose the one that provided the best customer service and the most user-friendly platform for our specific users.
- Kimberly Askren, PharmD at Boone County Hospital
Impact
Implementing InsightRX delivered real, practical change in Boone County’s day-to-day operations. Clinicians no longer needed to coordinate special timing for labs; doses were computed rapidly with confidence. Workflows became leaner, clinician time was reallocated to more valuable tasks, and patients experienced fewer invasive lab draws:
- A streamlined monitoring protocol replaced the old two-draw manual approach
- Dose calculations shifted from manual spreadsheets to automated Bayesian models
- The platform’s analytics supported performance tracking for stewardship compliance
Results
Over approximately 50 vancomycin patients per year, Boone County saw zero nephrotoxicity events following deployment. In the first year, the proportion of patients achieving the desired therapeutic antibiotic range improved by 27%. In addition, the hospital realized substantial operational savings: $16,000 annually from reduced blood draws and $7,000 in pharmacist time savings. These gains underscore that even rural, resource-limited hospitals can successfully adopt precision dosing tools.
Conclusion
Boone County Hospital’s success story illustrates that model-informed precision dosing is not reserved for large academic centers. With the right platform and implementation support, even small critical access hospitals can realize meaningful gains in patient safety, operational efficiency, and cost savings. Boone’s experience provides a roadmap for other rural facilities aiming to modernize antibiotic dosing without adding undue burden.