Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients

Abstract

Background:Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin.Objective:Our objective was to evaluate vancomycin trough collection appropriateness before and after an initiative to change the dosing and trough collection times in ward patients.Methods:A retrospective cohort study of ward patients from May 2014-16 who received scheduled intravenous vancomycin was performed. Nurse managers and pharmacists provided staff education. Differences between pre- and post-intervention groups were compared using student’s t-test for continuous data and chi-square test for categorical data.Results:Baseline characteristics were similar between the pre-intervention (n=124) and post-intervention (n=122) groups except for weight-based maintenance dose (15.3 mg/kg vs. 16.5 mg/kg, p=0.03) and percentage of troughs collected with morning labs (14% vs. 87%, p<0.001). Patients in the pre- and post-intervention groups received a similar frequency of loading doses (14.5% vs. 16%, p=0.68). There was no significant difference in percentage of vancomycin troughs collected appropriately at 30 (40% vs. 42%, p=0.72), 60 (57% vs. 63%, p=0.35), or 75 (60% vs. 68%, p=0.22) minutes from the scheduled time of the next dose.Conclusion:Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.

Interventions targeting the prescribing and monitoring of vancomycin for hospitalized patients: a systematic review with meta-analysis

“…Three studies measured the impact of interventions on loading doses. 35 – 37 The overall frequency of receiving a loading dose for patients in the intervention group (112 of 263, 42.6%) compared to those receiving usual care (69 of 274, 25.2%) was not significantly different (OR 2.08, 95% CI 0.49–8.79; P =0.32). High heterogeneity among those studies was present ( I 2 =90%, P <0.01; Figure 3A ).…”

“…Three studies measured the effect of interventions on appropriate timing of trough blood samples for vancomycin assays prior to next dose. 35 , 38 , 39 There was no difference between patients in the intervention group (463 of 668, 69.3%) and those receiving usual care (302 of 569, 53.1%; OR 2.02, 95% CI 0.72–5.72; P =0.18), although there was significant heterogeneity between these studies ( I 2 =94%, ( P <0.01; Figure 4B ).…”

“…Five of the six studies were from the US 35 , 36 , 38 – 40 and one from Australia. 37 Three studies reported the population as number of patients, with 263 in the intervention group and 274 receiving usual care, 35 – 37 and one study reported treatment courses, with 200 in the intervention group and 279 receiving usual care. 38 Two studies that evaluated timing of blood samples for vancomycin assays exclusively reported only the number of concentrations: 387 in the intervention group and 288 receiving usual care.…”

“…All interventions involved education meetings. 35 – 40 Five studies employed multifaceted interventions, 35 – 38 , 40 including two or more interventions. Two studies involved implementation of guidance, educational meetings, and dissemination of educational materials.…”

“… 39 Of the four studies using guidance, two employed a clinical practice guideline, 37 , 38 one a nomogram, 36 and one an undefined policy change. 35 Dissemination of educational materials was employed in three studies using a pocket reference card ( Table 2 ). 37 , 38 , 40 Reported outcomes and effect sizes for studies employing interventions on dosing, monitoring, and nephrotoxicity outcomes are presented in Table 3 .…”