Aim To determine the level of compliance to age and critical drug monitoring parameters required for patients receiving carboplatin doses with therapeutic drug monitoring.1 This audit will focus on age at administration and, whether pharmacokinetic (PK) levels, audiology and creatinine clearance were conducted prior to administration of carboplatin as per the protocol.
Method Data was collected retrospectively from December 2018 till January 2019 of patients treated from 2017-present using the PK monitoring carboplatin in any protocol. Data collected includes -patient demographics, age at time of carboplatin administration, date of administration, course of treatment, target AUC, dose (actual, protocol and dose difference), whether audiology was completed, AUC levels and creatinine levels.2,3,4 The data was compared against set standards to determine percentage of compliance.
Results A total of 7 patients were identified as fitting the inclusion criteria – 3 males and 4 females – between them there were 26 courses of carboplatin. The patients had a variety of diseases – neuroblastoma (n=1), low grade glioma (n=1), astrocytoma (n=1) and retinoblastoma (n=4). 85.7% of patients (n=6) had audiology tests conducted, however only 28.6% (n=2) had them at baseline pre-treatment as per the protocol. All patients apart from two (71.4%) has their creatinine levels investigated prior to the first course of chemotherapy as per protocol. Of the 26 courses of carboplatin, 20 courses accurately received PK monitoring as per protocol where doses were modified as per the levels (76.9%). Furthermore, those following JOE chemotherapy protocol for retinoblastoma were all <3 months at the start of treatment and hence were within the age criteria to receive PK monitoring. The other disease states had a range of ages at the start of treatment from 2 months to 6 months, but still underwent PK monitoring for most of their treatment, i.e. only 2 (29%) patients did not meet the age criteria for PK monitoring.
Conclusion The findings showed that the correct age criteria were selected to receive PK monitoring, however typically they would monitor throughout their treatment even over 3 months. They also showed that the critical drug monitoring requirements before and whilst undergoing treatment with carboplatin were not consistently met for all patients as per protocols. To improve compliance to protocols, all practitioners should receive information on what monitoring requirements are necessary, when they need to be done and the importance of them for patient care, an SOP should be produced to include this information.
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