Identifying Safety Hazards Associated With Intravenous Vancomycin Through the Analysis of Patient Safety Event Reports

Abstract

Intravenous (IV) vancomycin is one of the most commonly used antibiotics in U.S. hospitals. There are several complexities associated with IV vancomycin use, including the need to have an accurate patient weight for dosing, to provide close monitoring to ensure appropriate drug levels, to monitor renal function, and to continue delivery of the medication at prescribed intervals. There are numerous healthcare system factors, including workflow processes, policies, health information technology, and clinical knowledge that impact the safe use of IV vancomycin. Past literature has identified several safety hazards associated with IV vancomycin use and there are some proposed solutions. Despite this literature, IV vancomycin–related safety issues persist. We analyzed patient safety event reports describing IV vancomycin–related issues in order to identify where in the medication process these issues were appearing, the type of medication error associated with each report, and general contributing factor themes. Our results demonstrate that recent safety reports are aligned with the issues already identified in the literature, suggesting that improvements discussed in the literature have not translated to clinical practice. Based on our analysis and current literature, we have developed a shareable infographic to improve clinician awareness of the complications and safety hazards associated with IV vancomycin and a self-assessment tool to support identification of opportunities to improve patient safety during IV vancomycin therapy. We also recommend development of clear guidelines to optimize health information technology systems to better support safe IV vancomycin use.

Vancomycin, A Common Home Infusion Antibiotic

“…When questionable results are obtained, such as an unexpectedly high trough level, retesting via venipuncture is recommended (Gorski et al, 2021). To maintain therapeutic levels, it is essential that doses be administered on schedule, commonly every 12 or 24 hours for intermittent infusions (Krukas et al, 2020).…”

“…Vancomycin is both an irritant (contributing to thrombophlebitis) and a vesicant which means extravasation of the drug outside of the vein may result in tissue injury (Gorski et al, 2017; Krukas et al, 2020). For patients receiving extended courses of vancomycin (i.e., weeks), guidelines recommend administration via a central line such as a peripherally inserted central catheter.…”

Uncovering Discrepancies in IV Vancomycin Infusion Records between Pump Logs and EHR Documentation

“…7,8 A recent study revealed that most vancomycin-related safety events occurred during the administration and monitoring process, resulting in medication errors including dose omission, delay, or improper dose. 9 Erroneously timed trough blood draw was significantly affecting the quality of the TDM process and solutions have been proposed to improve it. 7,10,11 However, little was known about the timing issue associated with other steps involved in IV vancomycin administration, despite that IV infusion administration is an error prone process.…”

Determinants of Intravenous Infusion Longevity and Infusion Failure via a Nonlinear Model Analysis of Smart Pump Event Logs: Retrospective Study

“…For example, patients receiving antibiotics who require therapeutic drug monitoring based on metrics like area under the concentration-time curve and trough levels often need blood draws before and after administration. The documented time of administration and subsequent blood draws are commonly based on the prescribed regimen and not on the actual completion of the infusion [ 3 , 4 ]. Infusion downstream and upstream occlusion alarms, when substantial, may also contribute to alarm fatigue among clinical staff [ 5 , 6 ].…”