School of Medicine and Health Sciences Poster Presentations

Title

Vancomycine Quality Improvement Project

Poster Number

307

Document Type

Poster

Publication Date

3-2016

Abstract

Background: Vancomycin is one of the most widely used intravenous antibiotics in the United States for the treatment of severe gram-positive infections, specifically methicillin-resistant Staphylococcus aureus. Under-dosing of this medication may result in ineffective treatment and an increased risk of vancomycin resistance. Over-dosing may increase the risk of side-effects such as nephrotoxicity. Troughs are used to guide dosing of vancomycin in order to maintain a therapeutic concentration (15-20 mcg/mL) that achieves a steady-state before the administration of the fourth dose. Therefore, a vancomycin trough must be timed just prior to the fourth dose to ensure that a therapeutic steady-state has been achieved. It is important for any medical facility to implement a system to determine whether medications are within their therapeutic window to reduce the risk of such complications.

Objective: To improve quality of care by increasing the percentage of appropriatelytimed vancomycin troughs through nursing education and the institution of a vancomycin order-set.

Methods: Data was collected through retrospective chart review of patients admitted to George Washington University Hospital who received greater than 4 doses of vancomycin before a trough was reported. Patients who received oral vancomycin, were dosed in the emergency department, received less than four doses, and those with an estimated GFR < 40 were excluded. Afterwards, the percentage of properly timed troughs was calculated. The interventions we plan to implement include: nursing and resident education regarding the necessity of proper timing in obtaining vancomycin troughs, coordination with the pharmacy in order to label bags of vancomycin with reminders, and an EMR order-set for ordering vancomycin along with an appropriately timed trough. Data collection and analysis will be repeated after each intervention.

Results: Data collection reveals that in the month of October 2014, 1550 doses of vancomycin were administered to 270 patients in the GWUH. Of these, 106 patients met inclusion criteria. Only 36 out of these 106 patients (34%) were identified to have appropriately timed vancomycin troughs.

Conclusions: The initial analysis of this study has revealed that only 34% of vancomycin troughs were timed properly. This confirms that there is much need for improvement in vancomycin level monitoring at GWUH to reduce the risks of the aforementioned complications. With interventions such as nursing education and order-set implementation, we hope to improve the efficacy of antibiotic therapy at GWUH.

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Presented at: GW Research Days 2016

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Vancomycine Quality Improvement Project

Background: Vancomycin is one of the most widely used intravenous antibiotics in the United States for the treatment of severe gram-positive infections, specifically methicillin-resistant Staphylococcus aureus. Under-dosing of this medication may result in ineffective treatment and an increased risk of vancomycin resistance. Over-dosing may increase the risk of side-effects such as nephrotoxicity. Troughs are used to guide dosing of vancomycin in order to maintain a therapeutic concentration (15-20 mcg/mL) that achieves a steady-state before the administration of the fourth dose. Therefore, a vancomycin trough must be timed just prior to the fourth dose to ensure that a therapeutic steady-state has been achieved. It is important for any medical facility to implement a system to determine whether medications are within their therapeutic window to reduce the risk of such complications.

Objective: To improve quality of care by increasing the percentage of appropriatelytimed vancomycin troughs through nursing education and the institution of a vancomycin order-set.

Methods: Data was collected through retrospective chart review of patients admitted to George Washington University Hospital who received greater than 4 doses of vancomycin before a trough was reported. Patients who received oral vancomycin, were dosed in the emergency department, received less than four doses, and those with an estimated GFR < 40 were excluded. Afterwards, the percentage of properly timed troughs was calculated. The interventions we plan to implement include: nursing and resident education regarding the necessity of proper timing in obtaining vancomycin troughs, coordination with the pharmacy in order to label bags of vancomycin with reminders, and an EMR order-set for ordering vancomycin along with an appropriately timed trough. Data collection and analysis will be repeated after each intervention.

Results: Data collection reveals that in the month of October 2014, 1550 doses of vancomycin were administered to 270 patients in the GWUH. Of these, 106 patients met inclusion criteria. Only 36 out of these 106 patients (34%) were identified to have appropriately timed vancomycin troughs.

Conclusions: The initial analysis of this study has revealed that only 34% of vancomycin troughs were timed properly. This confirms that there is much need for improvement in vancomycin level monitoring at GWUH to reduce the risks of the aforementioned complications. With interventions such as nursing education and order-set implementation, we hope to improve the efficacy of antibiotic therapy at GWUH.