Aims: The overarching aim of the NextDose project is to bring better dosing methods to the ward with target concentration intervention software. This includes two major steps of: providing a tool to allow pharmacometric model-based calculations useable by clinicians; and then actually getting them to use it. The goal is for doses to be determined by the best possible method, meaning real patients receiving doses that were determined (at least in part), by the most robust and accurate calculation method possible – not just the easiest to understand or most popular protocol.
Results: NextDose has been used in the care of over 90 patients receiving busulfan in Auckland. The majority were children under the age of 12. The median dose received has been close to that recommended by NextDose, being just 2% higher. Half of the dose changes made were within -6% and 10% of the NextDose recommended dose. However some doses were markedly different from the NextDose recommendation, in one case being 113% larger.
Conclusion: The NextDose project has met a number of practical challenges along the road to bring better dosing methods to the ward. Challenges include security of healthcare information, compatibility with ageing hospital computers, providing software support for an academic non-profit project, and trying to change routines in a clinical environment that is governed by multiple levels of management and policy. The limited data attained to date has been encouraging, supporting further research into software tools to improve target concentration intervention in hospitals.