The equity gap in precision dosing: a cross-sectional analysis of hospital-wide antimicrobial therapeutic drug monitoring implementation

Key Takeaways for GI Nurses

• Antimicrobial therapeutic drug monitoring (TDM) implementation reveals significant disparities in precision dosing access across different patient populations within hospital systems
• Equity gaps in antimicrobial dosing may disproportionately affect vulnerable populations who often present to GI services with complex infections and comorbidities
• Understanding TDM disparities is crucial for GI nurses managing patients with conditions like C. difficile infections, post-procedural complications, or immunocompromised states requiring antimicrobial therapy
• Hospital-wide implementation patterns of precision dosing technologies may influence medication safety protocols and patient outcomes in endoscopy and GI units

Clinical Relevance

For gastroenterology and endoscopy nurses, antimicrobial therapeutic drug monitoring represents a critical intersection of patient safety and health equity. GI patients frequently require antimicrobial therapy for conditions ranging from infectious complications following endoscopic procedures to complex intra-abdominal infections. When precision dosing through TDM is not equitably implemented, certain patient populations may receive suboptimal antimicrobial therapy, potentially leading to treatment failures, increased antimicrobial resistance, or adverse drug events. This is particularly concerning in GI practice where patients often have altered pharmacokinetics due to malabsorption, inflammatory conditions, or hepatic dysfunction.

The identification of equity gaps in TDM implementation should prompt GI nursing teams to critically evaluate their own unit practices and advocate for consistent access to precision dosing technologies. This may involve collaborating with pharmacy teams to ensure high-risk GI patients—including those with inflammatory bowel disease, liver disease, or post-surgical complications—receive appropriate antimicrobial monitoring regardless of their demographic characteristics or insurance status. Additionally, understanding these disparities can inform quality improvement initiatives and help establish protocols that ensure equitable access to optimal antimicrobial therapy across all patient populations served by GI services.

From an operational perspective, this research highlights the importance of systematic approaches to implementing evidence-based practices like TDM. GI nurses play a vital role in identifying patients who would benefit from precision antimicrobial dosing, coordinating with multidisciplinary teams for appropriate monitoring, and ensuring that technological advances in pharmacotherapy are applied equitably. This knowledge can also inform continuing education priorities and competency development programs within GI nursing teams.

Bottom Line

This cross-sectional analysis reveals concerning equity gaps in antimicrobial therapeutic drug monitoring implementation, which directly impacts GI nursing practice by highlighting potential disparities in precision dosing access for patients who frequently require antimicrobial therapy for infectious complications, post-procedural infections, and complex GI conditions. GI nurses must be aware of these disparities and actively advocate for equitable implementation of TDM practices to ensure all patients receive optimal antimicrobial therapy regardless of demographic characteristics, ultimately improving patient outcomes and reducing the risk of antimicrobial resistance in vulnerable populations commonly seen in gastroenterology and endoscopy settings.