HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) All Versions of this Article: jcp.2006.044727v1 60/10/1155    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Crowley, R K Articles by Smyth, E G Search for Related Content PubMed PubMed Citation Articles by Crowley, R K Articles by Smyth, E G Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Antibiotics Hazardous Substances DB VANCOMYCIN

Vancomycin administration: the impact of multidisciplinary interventions

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