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Vancomycin administration: the impact of multidisciplinary interventions
  1. Rachel K Crowley (rachelcrowley{at}beaumont.ie)
  1. Beaumont Hospital, Republic of Ireland
    1. Fidelma M Fitzpatrick (fidelmafitz{at}eircom.net)
    1. Beaumont Hospital, Dublin, Republic of Ireland
      1. Damodar Solanki (damodarsolanki{at}beaumont.ie)
      1. Beaumont Hospital, Republic of Ireland
        1. Susan Fitzgerald (suzyfitz{at}eircom.net)
        1. Beaumont Hospital, Republic of Ireland
          1. Hilary Humphreys (hhumphreys{at}rcsi.ie)
          1. Royal College of Surgeons in Ireland, Republic of Ireland
            1. Edmond G Smyth (edmondsmyth{at}beaumont.ie)
            1. Beaumont Hospital, Republic of Ireland

              Abstract

              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 three (16% (27/170) of prescribed doses) when compared to audit one (25% (69/282) of doses) (p<0.05).

              Conclusions: Our 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.

              • audit
              • therapeutic drug monitoring
              • vancomycin

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