We’ve been able to successfully utilize world-class precision dosing solutions for the benefit of our staff and ultimately our patient population, who can receive award-winning care close to home.
Opportunity
Vancomycin is widely used in hospitals to treat serious infections, but achieving optimal drug exposure is challenging. The 2020 IDSA/ASHP guidelines recommend AUC-guided dosing over traditional trough monitoring, as trough levels poorly correlate with clinical outcomes and are associated with increased nephrotoxicity.1 Vancomycin levels outside the target range can cause acute kidney injury (AKI), leading to worsening patient conditions, longer hospital stays, and higher costs — with AKIs impacting nearly half a million U.S. patients annually at a cost of $4.7 to $24 billion.2
At Mount Nittany Medical Center, a 260-bed community hospital in State College, Pennsylvania, pharmacy leadership sought to transition from trough-based monitoring to AUC-guided dosing while improving operational efficiency. The challenge was implementing a method that would improve accuracy without adding burden to the 26-pharmacist department, particularly during weekends and off-shifts. The hospital also integrated InsightRX with Premier (PINC AI) Clinical Surveillance & TheraDoc® to enable clinical monitoring and decision support.
Solution
Mount Nittany Medical Center implemented InsightRX's Nova precision dosing platform integrated with PINC AI Clinical Surveillance powered by TheraDoc in Q3 2021, adopting Bayesian model-informed precision dosing (MIPD) for vancomycin. The implementation process included a three-person super user team that updated EMR workflows, policies, and monitoring forms while training the 26-pharmacist department.
The InsightRX platform uses population pharmacokinetic models and Bayesian forecasting to generate individualized dosing recommendations and allows for flexible timing of drug levels—including random AM levels rather than traditional trough timing. This flexibility proved crucial for streamlining weekend workflow, as pharmacists could obtain vancomycin levels during routine morning lab draws without requiring additional patient blood draws or timing constraints.
Impact
Following implementation in Q3 2021, Mount Nittany Medical Center tracked performance through Q4 2022. The percentage of patients achieving target AUC increased from 52% at baseline to 64% by Q4 2022 (a 12 percentage point improvement over six quarters). Most importantly, the AKI rate for patients on vancomycin for 48+ hours dropped to just 1% in Q4 2022.
Beyond clinical outcomes, the MIPD approach with flexible random level timing enabled significant workflow improvements, particularly allowing the hospital to safely reduce weekend staffing requirements:
- Pharmacists reported increased efficiency, especially on second and third shifts
- Pharmacists gained real-time visibility on patient-level AUC attainment and deviations
- Monitoring and pharmacovigilance were streamlined via integration with TheraDoc and PINC AI
- The enhanced decision support empowered more confident dosing in complex patient cases
We're thrilled with how our data compares against industry benchmarks.
Results
Over the monitoring period, Mount Nittany increased the proportion of patients whose vancomycin AUCs fell within target range by 12 percentage points. In Q4 2022, only 1% of patients experienced AKI within 48 hours of vancomycin initiation — significantly below typical industry average for trough-based dosing. By outperforming insightRX’s benchmark averages and achieving extremely low nephrotoxicity rates, Mount Nittany demonstrated that precision dosing can scale in community hospital settings.
Using Bayesian MIPD via InsightRX increased target AUC attainment from 52% to 64%
Mount Nittany Medical Center showed steady improvement in target attainment following implementation. Starting at 52% in Q3 2021, performance increased steadily after implementation, and reached 64% in Q4 2022.
Figure 1 shows the proportion of patients within the target AUC range, by quarter.
Using Bayesian MIPD via InsightRX reduced AKI rates to 1%
By Q4 2022, only 1% of Mount Nittany patients experienced an AKI 48 hours after initiation of vancomycin therapy, compared to the industry average of 16% (range 5-43%) when using trough based dosing.3
The hospital maintained consistently low AKI rates throughout the evaluation period (between 1 and 5% each quarter). In comparison, the all-organizational average for institutions using the same Bayesian software remained in the 6-8% range. These results demonstrate that Bayesian MIPD can achieve exceptional patient safety outcomes even in a community hospital setting.
Figure 2 shows AKI rates by quarter for Mount Nittany (bars) vs. average of all InsightRX customers (solid line) and industry average for trough-based dosing (dotted line).
Conclusions
Mount Nittany Medical Center's success demonstrates that community hospitals can achieve outcomes rivaling large academic centers by adopting Bayesian MIPD for vancomycin dosing. The 1% AKI rate and consistent performance above organizational benchmarks reflect both the power of precision dosing and the thoroughness of the implementation process.
Beyond clinical outcomes, the operational benefits (particularly the ability to use random AM levels and reduce weekend staffing) provided immediate value to the pharmacy department. Through integration with clinical surveillance platforms and evidence-based Bayesian dosing, Mount Nittany achieved better target attainment and minimized AKI rates — all while optimizing clinical workflows. This case offers a replicable model for other health systems aiming to modernize antimicrobial monitoring.
Along with Holyk, Hayden Hayward, PharmD, and Jessica McDonald, PharmD, Pharmacy Department, Mount Nittany Medical Center, were inducted into the 2022 CHART Institute Patient Safety Hall of Fame in recognition of their efforts in implementing Bayesian dosing software, InsightRX, to assist with vancomycin dosing.
This success story was adopted from a continuing education session presented at the Premier Breakthroughs 2023 conference. Mount Nittany also published a joint press release with InsightRX as well, detailing the successes of their implementation.