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

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Abstract 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.

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