ORIGINAL ARTICLES

Vancomycin administration: the impact of multidisciplinary interventions

R K Crowley¹, F Fitzpatrick¹, D Solanki², S FitzGerald¹, H Humphreys¹ and E G Smyth¹

¹ Departments of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
² Department of Pharmacy, Beaumont Hospital, Dublin, Ireland

Correspondence to:
Dr Rachel Crowley, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; rachelcrowley{at}beaumont.ie

Background: The clinical microbiology team observed that patients were not receiving all prescribed doses of vancomycin. Ward staff was confused about ordering and interpreting vancomycin therapeutic drug monitoring (TDM) levels.

Aim: To audit the incidence of vancomycin dose omission. To implement a series of interventions to improve vancomycin dose administration, and to repeat the audit process to assess these interventions.

Methods: Three prospective audits were conducted to assess the impact of vancomycin TDM on administration of vancomycin. After the first audit, a number of changes in the TDM process were undertaken. After review of the second audit, a senior pharmacist coordinated ward-based pharmacists in assisting staff to interpret levels, and TDM interpretative charts were designed for drug charts. Following the third audit, feedback to hospital management and a plan for ongoing education were undertaken.

Results: There was a significant reduction in the number of vancomycin doses held inappropriately in the third (10% (78/782) of prescribed doses) when compared to the first audit (16% (161/1007) of doses) (p<0.01). Of doses that were held inappropriately, there was a significant decrease in doses held for no apparent reason in audit 3 (16% (27/170) of prescribed doses) when compared to audit 1 (25% (69/282) of doses) (p<0.05).

Conclusions: The interventions resulted in a 37.5% reduction in inappropriately held vancomycin doses over a one-year period; 10% of doses are still being held inappropriately. This study highlights the difficulties in identifying barriers to change and changing healthcare worker behaviour.

Abbreviations: TDM, therapeutic drug monitoring

Keywords: vancomycin; therapeutic drug monitoring; audit

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