Improvement of vancomycin utilization in a community teaching hospital

Purpose: Pharmacokinetic parameters must be taken into consideration to optimize the utilization of agents such as vancomycin. Currently, at our institution, dosing and monitoring does not follow a standardized approach which may potentiate suboptimal outcomes. The objective of this study was to implement a pharmacist-driven pharmacokinetic service to improve the utilization of vancomycin.

Methods: A three month prospective study was conducted at Hunterdon Medical Center. Quadramed Computerized Patient Record System (QCPR) was utilized to identify patients receiving at least one dose of vancomycin from January 2012 to March 2012. Patients were evaluated for appropriateness of initial dosing based on weight and renal function and pharmacokinetics were calculated for all subsequent doses. This dosing strategy was used to assess for therapeutic troughs and compare to retrospective data collected January 2011 to May 2011.

Results: One hundred and seven patients in the Phase II portion of the study received at least one dose of vancomycin; of these forty-seven patients (43.9%) were able to attain a therapeutic trough as compared to the seventeen out of one hundred patients (17%) included in Phase I of the study (P=0.00010). Improvements were seen when assessing the percentage of patients who were able to attain a therapeutic first trough in Phase I and II, 25% and 39.3%, respectively (P=0.0372). In assessing composite number of troughs not drawn there were forty-seven patients who were not monitored with troughs in Phase I and thirty-five patients in Phase II who required troughs but did not have them drawn (P= 0.1349); one hundred and nineteen troughs were requested in Phase II. Forty-eight cost saving interventions were recommended and accepted, including dose increases/decreases, frequency increases/decreases, and discontinuation of the agent.

Conclusion: Improvement in vancomycin utilization was observed after the implementation of a pharmacist-driven pharmacokinetic service.