Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients

Drayton A. Hammond, Lexis N. Atkinson, Taylor B. James, Jacob T. Painter, Katherine Lusardi

Abstract


Background: Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin.

Objective: Our objective was to evaluate vancomycin trough collection appropriateness before and after an initiative to change the dosing and trough collection times in ward patients.

Methods: A retrospective cohort study of ward patients from May 2014-16 who received scheduled intravenous vancomycin was performed. Nurse managers and pharmacists provided staff education. Differences between pre- and post-intervention groups were compared using student's t-test for continuous data and chi-square test for categorical data.

Results: Baseline characteristics were similar between the pre-intervention (n=124) and post-intervention (n=122) groups except for weight-based maintenance dose (15.3 mg/kg vs. 16.5 mg/kg, p=0.03) and percentage of troughs collected with morning labs (14% vs. 87%, p<0.001). Patients in the pre- and post-intervention groups received a similar frequency of loading doses (14.5% vs. 16%, p=0.68). There was no significant difference in percentage of vancomycin troughs collected appropriately at 30 (40% vs. 42%, p=0.72), 60 (57% vs. 63%, p=0.35), or 75 (60% vs. 68%, p=0.22) minutes from the scheduled time of the next dose.

Conclusion: Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.


Keywords


Vancomycin; Drug Monitoring; Pharmacists; Dose-Response Relationship, Drug; Plasma; Pharmacokinetics; Quality Improvement; Retrospective Studies; United States

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References


Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O'Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. doi: 10.1093/cid/ciw353

Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC, Craig WA, Billeter M, Dalovisio JR, Levine DP. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009;49(3):325-327. doi: 10.1086/600877

van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother. 2013;57(2):734-744. doi: 10.1128/AAC.01568-12

Bentley ML, Corwin HL, Dasta J. Drug-induced acute kidney injury in the critically ill adult: recognition and prevention strategies. Crit Care Med. 2010;38(6 Suppl):S169-S174. doi: 10.1097/CCM.0b013e3181de0c60

Hammond DA, Smith MN, Li C, Hayes SM, Lusardi K, Bookstaver PB. Systematic review and meta-analysis of acute kidney injury associated with concomitant vancomycin and piperacillin/tazobactam. Clin Infect Dis. 2017 [ahead of print]. doi: 10.1093/cid/ciw811

Burgess LD, Drew RH. Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam. Pharmacotherapy. 2014;34(7):670-676. doi: 10.1002/phar.1442

Davies SW, Efird JT, Guidry CA, Dietch ZC, Willis RN, Shah PM, Sawyer RG. Top guns: the "Maverick" and "Goose" of empiric therapy. Surg Infect (Larchmt). 2016;17(1):38-47. doi: 10.1089/sur.2015.104

Fodero KE, Horey AL, Krajewski MP, Ruh CA, Sellick JA Jr, Mergenhagen KA. Impact of an antimicrobial stewardship program on patient safety in veterans prescribed vancomycin. Clin Ther. 2016;38(3):494-502. doi: 10.1016/j.clinthera.2016.01.001

Gomes DM, Smotherman C, Birch A, Dupree L, Della Vecchia BJ, Kraemer DF, Jankowski CA. Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillin-tazobactam or cefepime. Pharmacotherapy. 2014;34(7):662-669. doi: 10.1002/phar.1428

Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K. Concomitant vancomycin and piperacillin-tazobactam does not increase acute kidney injury in critically ill patients. Pharmacotherapy. 2016;36(5):463-471. doi: 10.1002/phar.1738

Kim T, Kandiah S, Patel M, Rab S, Wong J, Xue W, Easley K, Anderson AM. Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy. BMC Res Notes. 2015;8:579. doi: 10.1186/s13104-015-1518-9

Navalkele B, Pogue JM, Karino S, Nishan B, Salim M, Solanki S, Pervaiz A, Tashtoush N, Shaikh H, Koppula S, Koons J, Hussain T, Perry W, Evans R, Martin ET, Mynatt RP, Murray KP, Rybak MJ, Kaye KS. Risk of Acute kidney injury in patients on concomitant vancomycin and piperacillin/tazobactam compared to those on vancomycin and cefepime. Clin Infect Dis. 2017;64(2):116-123. doi: 10.1093/cid/ciw709

Sutton JD, Mynatt RP, Kaye KS, Murray KP, Rybak MJ, Pogue JM. Nephrotoxicity comparison of two commercially available generic vancomycin products. Antimicrob Agents Chemother. 2015;59(9):5470-5474. doi: 10.1128/AAC.00388-15

Ragab AR, Al-Mazroua MK, Al-Harony MA. Incidence and predisposing factors of vancomycin-induced nephrotoxicity in children. Infect Dis Ther. 2013;2(1):37-46. doi: 10.1007/s40121-013-0004-8

Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med. 2006;166(19):2138-2144. doi: 10.1001/archinte.166.19.2138

Lodise TP, Patel N, Lomaestro BM, Rodvold KA, Drusano GL. Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients. Clin Infect Dis. 2009;49(4):507-514. doi: 10.1086/600884

Lodise TP, Lomaestro B, Graves J, Drusano GL. Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity. Antimicrob Agents Chemother. 2008;52(4):1330-1336. doi: 10.1128/AAC.01602-07

Davis SL, Scheetz MH, Bosso JA, Goff DA, Rybak MJ. Adherence to the 2009 consensus guidelines for vancomycin dosing and monitoring practices: a cross-sectional survey of U.S. hospitals. Pharmacotherapy. 2013;33(12):1256-1263. doi: 10.1002/phar.1327

Steinmetz T, Eliakim-Raz N, Goldberg E, Leibovici L, Yahav D. Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis. Clin Microbiol Infect. 2015;21(7):665-673. doi: 10.1016/j.cmi.2015.04.003

Swartling M, Gupta R, Dudas V, Guglielmo BJ. Short term impact of guidelines on vancomycin dosing and therapeutic drug monitoring. Int J Clin Pharm. 2012;34(2):282-285. doi: 10.1007/s11096-012-9614-6

Coleman LK, Wilson AS. Impact of nursing education on the proportion of appropriately drawn vancomycin trough concentrations. J Pharm Pract. 2016;29(5):472-474. doi: 10.1177/0897190014568381

Howanitz PJ, Cembrowski GS, Bachner P. Laboratory phlebotomy. College of American Pathologists Q-Probe study of patient satisfaction and complications in 23,783 patients. Arch Pathol Lab Med. 1991;115(9):867-872.

Miller AD, Piro CC, Rudisill CN, Bookstaver PB, Bair JD, Bennett CL. Nighttime and weekend medication error rates in an inpatient pediatric population. Ann Pharmacother. 2010;44(11):1739-1746. doi: 10.1345/aph.1P252

Morrison AP, Melanson SE, Carty MG, Bates DW, Szumita PM, Tanasijevic MJ. What proportion of vancomycin trough levels are drawn too early?: frequency and impact on clinical actions. Am J Clin Pathol. 2012;137(3):472-478. doi: 10.1309/AJCPDSYS0DVLKFOH


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