Implementing use of cystatin C-guided estimated glomerular filtration rate for medication dosing at an Academic Medical Center

Accurate kidney function assessment is essential for medication dosing, although traditional methods such as urine output and serum creatinine are limited, especially in patients with acute kidney injury. Cystatin C was made available as an alternative marker at our institution, prompting the formation of a multidisciplinary task force to guide its use and resolve discrepancies in clinical practice using a Plan-Do-Study-Act framework. Plan-Do-Study-Act is a validated approach to developing and evaluating interventions to ensure that changes to a process result in the desired improvement. The task force developed pharmacist-focused education, creating guidance documents and asynchronous training with competency assessments. An audit revealed that cystatin C was primarily used in intensive care units for dosing antibiotics like cefepime and vancomycin. In response, updates to clinical decision support systems in electronic medical records were made. A progress note template was designed and implemented to communicate cystatin C assessments and dosing changes based on this kidney filtration marker. Ongoing quality improvement efforts are focusing on broadening education, refining documentation, and researching optimal cystatin C use.