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

Key Takeaways for GI Nurses

• Therapeutic drug monitoring (TDM) for antimicrobials may not be equitably implemented across all patient populations, potentially affecting GI patients who frequently receive these medications for infections or prophylaxis
• Precision dosing gaps could impact vulnerable patient populations who may already face healthcare disparities, including those with complex GI conditions requiring extended antimicrobial therapy
• Hospital-wide implementation of antimicrobial TDM requires systematic approaches that ensure all patients receive appropriate monitoring regardless of demographic factors
• GI nurses should be aware of potential equity issues in medication monitoring protocols and advocate for consistent application of precision dosing practices across their patient population

Clinical Relevance

For gastroenterology and endoscopy nurses, this research highlights critical considerations around antimicrobial stewardship and patient safety. GI patients often require antimicrobial therapy for various indications, including treatment of Helicobacter pylori, management of inflammatory bowel disease-related infections, prophylaxis for immunocompromised patients, and treatment of procedure-related complications. If therapeutic drug monitoring implementation varies based on patient demographics or other non-clinical factors, some patients may not receive optimal antimicrobial dosing, potentially leading to treatment failure, increased resistance, or adverse effects.

The equity implications are particularly relevant in GI nursing practice, where patient populations often include diverse demographics and varying socioeconomic backgrounds. Nurses play a crucial role in medication administration, monitoring, and patient education, making them well-positioned to identify and address disparities in care delivery. Understanding these potential gaps in precision dosing can help GI nurses advocate for standardized protocols and ensure that all patients receive evidence-based antimicrobial monitoring regardless of their background or characteristics.

From an operational standpoint, this research underscores the importance of developing and implementing standardized TDM protocols that are applied consistently across all patient populations. GI nurses should work collaboratively with pharmacy teams, physicians, and quality improvement committees to establish clear guidelines for when and how antimicrobial levels should be monitored, ensuring that clinical decision-making is based on evidence rather than potentially biased assumptions about patient populations.

Bottom Line

This research reveals potential equity gaps in how hospitals implement antimicrobial therapeutic drug monitoring, which is particularly relevant for GI nurses given their patients' frequent need for antimicrobial therapy. The key takeaway is that precision dosing practices must be systematically and equitably applied to ensure all patients receive optimal antimicrobial treatment outcomes, regardless of demographic factors, and GI nurses should advocate for standardized monitoring protocols while remaining vigilant for potential disparities in their own practice settings.