Title : The peaks and troughs of vancomycin compliance
Abstract:
Background: Vancomycin is a powerful antibiotic that is used to treat many infections. The monitoring of this medication (peak and trough) is extremely critical to its effectiveness. Vancomycin discrepancies have increased by 17.4% over 15-months.
Aims: The aim is to decrease Vancomycin protocol discrepancies through education and surveillance on two nursing units.
Methods: Study design is a two-phase, pre/post intervention chart review of patients ordered Vancomycin and education of nursing staff. Data was collected from all full-time, part time, and casually employed registered nurses on a Medical/Surgical Unit and a Progressive Care Unit during a pre-quiz was given prior to education session and followed by a post quiz. Another post three-month quiz was administered to the same staff. Vancomycin discrepancies were monitored for three months preceding education and three months post education to monitor the discrepancies compared to the patients that were ordered Vancomycin.
Results: There was a statistically significant difference between pre-quiz / post quiz scores (p<0.0001). There was a statistically significant difference between post- and 3-month errors (p= 0.002). Regarding Vancomycin Protocol Discrepancies, there was no statistically significant association (p-value = 0.84) on the Medical/Surgical Unit but there was a significant statistically association Χ2 = 4.89 (p-value = 0.03) on the Progressive Care Unit.
Conclusion: The discrepancy rate for Vancomycin decreased after the education in-service for nurses. Therefore, ongoing education is needed for nurses to recognize the importance of Vancomycin compliance. It is vital that physicians and pharmacists are included in future educational endeavors.
Audience Take Away Notes:
- The monitoring of Vancomycin is extremely critical due to its narrow therapeutic window for effectiveness and possibility for renal toxicity.
- Education is needed for all nursing staff, specifically for Vancomycin, and not general antimicrobials.
- The need for an accurate height and weight (not estimated) and Serum Creatinine (This will determine if renal impairment is present prior to therapy. Serum creatinine is necessary to calculate the clearance).
- This education that will be presented can provide a better workflow and understanding to hospital units for vancomycin compliance. By providing a simple education plan, the missed laboratory tests or missed timed doses of medications can be eliminated for better overall Vancomycin compliance. This can potentially provide better outcomes for our patients.
