Improving the correct prescription and dosage of gentamicin

Qureshi, Imran Ahmad; Habayeb, Hani; Grundy, Clive

doi:10.1136/bmjquality.u134.w317

Cited by 6 publications

(3 citation statements)

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“…Prophylactic doses were also excluded from the study. 17 However, it was conducted only on surgical wards, had a relatively small sample size (only 50 patients in each phase) and no statistical analysis was conducted. Another study conducted in Taiwan investigated the impact of an online gentamicin dose calculator incorporated into the hospital CPOE system, using a pharmacokinetic formula to provide the correct dose.…”

Section: Discussionmentioning

confidence: 99%

A pre–postintervention study to evaluate the impact of dose calculators on the accuracy of gentamicin and vancomycin initial doses

et al. 2015

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ObjectivesGentamicin and vancomycin are narrow-therapeutic-index antibiotics with potential for high toxicity requiring dose individualisation and continuous monitoring. Clinical decision support (CDS) tools have been effective in reducing gentamicin and vancomycin dosing errors. Online dose calculators for these drugs were implemented in a London National Health Service hospital. This study aimed to evaluate the impact of these calculators on the accuracy of gentamicin and vancomycin initial doses.MethodsThe study used a pre–postintervention design. Data were collected using electronic patient records and paper notes. Random samples of gentamicin and vancomycin initial doses administered during the 8 months before implementation of the calculators were assessed retrospectively against hospital guidelines. Following implementation of the calculators, doses were assessed prospectively. Any gentamicin dose not within ±10% and any vancomycin dose not within ±20% of the guideline-recommended dose were considered incorrect.ResultsThe intranet calculator pages were visited 721 times (gentamicin=333; vancomycin=388) during the 2-month period following the calculators’ implementation. Gentamicin dose errors fell from 61.5% (120/195) to 44.2% (95/215), p<0.001. Incorrect vancomycin loading doses fell from 58.1% (90/155) to 32.4% (46/142), p<0.001. Incorrect vancomycin first maintenance doses fell from 55.5% (86/155) to 33.1% (47/142), p<0.001. Loading and first maintenance vancomycin doses were both incorrect in 37.4% (58/155) of patients before and 13.4% (19/142) after calculator implementation, p<0.001.ConclusionsThis study suggests that gentamicin and vancomycin dose calculators significantly improved the prescribing of initial doses of these agents. Therefore, healthcare organisations should consider using such CDS tools to support the prescribing of these high-risk drugs.

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Section: Discussionmentioning

confidence: 99%

A pre–postintervention study to evaluate the impact of dose calculators on the accuracy of gentamicin and vancomycin initial doses

et al. 2015

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“…1 In clinical practice, there are many drugs which require close monitoring to avoid adverse effects, these studies have used various methods to ensure accurate monitoring to improve patient's safety. [2][3][4] According to the British National Formulary (BNF), it is necessary to correct disturbances of calcium metabolism before starting bisphosphonate infusion (2). Patients with significantly low 25-OHD are at risk of developing bisphosphonate-induced hypocalcaemia.…”

Section: Introductionmentioning

confidence: 99%

Improving Bisphosphonate Infusion Monitoring at Haematology Medical Day Unit

Ong

Jones

2017

BMJ Qual Improv Report

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This project was started after an incident of bisphosphonate-induced hypocalcaemia in September 2015. As part of management of lytic bone lesions in patients with multiple myeloma were given either Zoledronic Acid or Pamidronate Disodium at our Haematology Day Unit. According to the British National Formulary (BNF), it is necessary to correct disturbances of calcium metabolism (e.g. vitamin D deficiency, hypocalcaemia) and consider dental check-ups before starting bisphosphonate infusion due to the risk of osteonecrosis of the jaw. There was no formal checklist in place for all patients prior to starting bisphosphonate infusion. The aim of this quality improvement project was (1) to avoid preventable bisphosphonate induced adverse effects, (2) to improve safety of bisphosphonate prescribing and administration and (3) to increase patient's awareness of needing regular dental checks. Interventions were modified over multiple Plan-Do-Study-Act (PDSA) improvement cycles to improve bisphosphonate infusion monitoring and patient safety.There was an overall improvement in ensuring safety checks were done prior to administration of bisphosphonate infusion compared to baseline measurements. At baseline, 36% (n=9) of patients had a dental check within the last 6 months; after PDSA cycle 3, there was an improvement of up to 69% (n=11). All patients had renal function and bone profile checked prior to infusion from throughout the study. It was all recorded in the blood results section of the checklist with no missing data. We found that 32% (n=8) of patients had never had 25-OHD at baseline. After PDSA cycle 3, all patients had 25-OHD checked at some point.

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“…Previous quality projects gave improved the prescription of gentamicin by implementing an online calculator. [ 3 ] While our trust already utilises an online calculator for initial prescription, it has become clear that more intervention is needed to provide effective patient care.…”

Section: Introductionmentioning

confidence: 99%

Using a simple handover to improve the timing of gentamicin levels

Williamson

Bradley

Khan

2015

BMJ Qual Improv Report

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The aminoglycoside gentamicin is commonly used in many NHS trusts to cover gram negative organisms in intra-abdominal sepsis and sepsis of unknown origin. As a result it often forms an important part of thew “Sepsis 6” protocol on surgical wards. Despite it's effectiveness, the antibiotic is well known to have nephrotoxic and ototoxic side effects, making monitoring of serum levels vital. In Hairmyres Hospital, a busy district general hospital in Lanarkshire, levels are typically taken at six to 14 hour post-dose intervals, with the result guiding further gentamicin dosing.A baseline measurement was performed highlighting that 42.2% of these levels were taken after the 14 hour limit. This was thought to have serious implications for patient's, as levels designed to protect them from side effects whilst maintain g an effective antimicrobial action were not being performed properly. As a result, a “gentamicin handover” was introduced to the wards in order to ease the workload on junior staff and improve handover between teams.During our short project the number of late levels initially dropped to 33.3% after one week, falling further to 28.6% following the second week of intervention. From our results it is clear that while more intervention is required gentamicin prescription, this project highlights how a simple intervention to improve ward handover can create a very noticeable improvement in the quality of patient care within a small time period.

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Improving the correct prescription and dosage of gentamicin

Abstract: Gentamicin is an amino glycoside antibiotic, which is used predominantly in gram-negative infections but also has anti-staphylococcal activity. It is commonly used because of its lack of diffogenicity. There are recognised issues with its dosing of which time is a major factor.

Cited by 6 publications

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A pre–postintervention study to evaluate the impact of dose calculators on the accuracy of gentamicin and vancomycin initial doses

A pre–postintervention study to evaluate the impact of dose calculators on the accuracy of gentamicin and vancomycin initial doses

Improving Bisphosphonate Infusion Monitoring at Haematology Medical Day Unit

Using a simple handover to improve the timing of gentamicin levels

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