Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance

Abstract

Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement.

An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012

“…There were differences in the incident patterns from those reported by critical care units to the National Patient Safety Agency during 2008 [6]; gentamicin and vancomycin were the second and fifth most common drugs described in 2008, but were each described fewer than five times in our study, possibly due to improvements in dosing protocols [22,23]. Failure to prescribe drugs according to local protocols was the third most frequent prescription problem we identified, being much less common in our previous review; we speculate that local care protocols have become more widespread since 2008.…”

Implementation and strength of root cause analysis recommendations following serious adverse events involving paediatric patients in the Queensland public health system between 2012 and 2014

“…7,8 There are, however, several small studies in the literature that demonstrate a decrease in a specific adverse event or a decrease in the incidence of a root cause that contributed to the event. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Conversely, a recent large retrospective study of 302 RCAs in a New York hospital showed that multiple event types, such as retained foreign body, medication administration error and wrong-site surgery, occurred repeatedly in the study period despite repeated RCAs being performed. 26 In the absence of a controlled trial that tests the validity of the RCA framework in health care, there are several parameters that can be monitored to evaluate recommendations arising from RCA as a surrogate measure of their efficacy.…”

“…Despite the widespread use of RCA in health care and the significant costs associated with the process, there has been no formal evaluation of the ability of the RCA process to improve patient safety . There are, however, several small studies in the literature that demonstrate a decrease in a specific adverse event or a decrease in the incidence of a root cause that contributed to the event . Conversely, a recent large retrospective study of 302 RCAs in a New York hospital showed that multiple event types, such as retained foreign body, medication administration error and wrong‐site surgery, occurred repeatedly in the study period despite repeated RCAs being performed …”

Extended-Interval Dosing of Aminoglycosides in Pediatrics: A Narrative Review

“…The role of therapeutic drug monitoring (TDM) in EID of AGs is not clear. In spite of evidences supporting the use of TDM in neonates (27,28) and adults (29,30), there are several studies that propose routine TDM is not necessary in practice. In a cohort of 79 children (median age: 5.6 years), gentamycin 7 mg/kg/day was administered as EID.…”