A Device to Improve Collaborative Practices of Sanitation Department Agents of a Territory: The Case of the Lamkansa District in Casablanca

The aim of this article is to strengthen and improve the collaboration between professional agents of a service that manages one of the technical processes acting on a given territory by synchronizing the spatio-temporal dimensions including all agents assembled for the task. This proposal was tested in the Lamkansa neighborhood in Casablanca, Morocco. The employed approach is based GIS resources and on systemic analysis of communication present in a territory. We were inspired by several methodological developments that carried multi-actor processes in land use planning. We focused our work on strengthening the collaboration between professionals, field agents and office agents, in the process of design and monitoring the liquid sanitation system. The device is based on geolocation and synchronous feedback of topological, geographical, and multimedia data related to the liquid sanitation network. Thanks to a geo-collaborative, participative, and motivating logic, we reduced the management costs of the network and made it faster and more efficient by equally mobilizing another type of non-specialized actors (the inhabitants). This device uses spatial and temporal dimensions to consolidate collaborative work tools through ICT and GIS technologies that thematize and exchange information collected in the field. Furthermore, this device raises great interest as it entails the concept of integration of several actors in a geo-collaborative mode while combining geomatics with communication and information sciences.

Pharmacist and Physician Collaborative Practice Model Improves Vancomycin Dosing in an Intensive Care Unit

Objective: A pharmacist and physician collaborative practice intervention to improve the initial dosing of vancomycin was implemented with the goal of decreasing the number of subtherapeutic first troughs and increasing the number of therapeutic troughs. Methods: Using the best available evidence, a nomogram was created to determine the initial vancomycin dose. The nomogram utilized actual bodyweight and glomerular filtration rate (eGFR) estimated with the MDRD4 equation. The dose was based on the 2009 ASHP/IDSA/SIDP guidelines, which recommended 15 - 20 mg/kg every 8 - 12 hours. Providers ordered “vancomycin IV dosed per pharmacy”. Results: The pre- (n = 75) and post-intervention (n = 108) cohorts had similar age, gender distribution, weight, and eGFR. The median total daily vancomycin dose was similar in pre- and post-intervention groups (2000 mg), although the median first trough was higher following the intervention (13.0 vs. 14.8 mcg/ml, p = 0.03). Following the intervention, the proportion of first troughs under 10 mcg/ml decreased (32% to 13%, p = 0.003), while the proportion of troughs in the 10 - 20 mcg/ml therapeutic range increased (50.7% vs. 69.4%, p = 0.01). There was no difference in the proportion of troughs over 20 mcg/ml (17.3% vs. 17.6%, p = 0.96). Conclusions: A multi-disciplinary intervention utilizing a nomogram-based pharmacy collaborative practice model significantly improves the proportion of therapeutic initial vancomycin troughs and decreases the number of subtherapeutic troughs by half.