Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
Int J Clin Pharm. 2012 Apr;34(2):282-5. doi: 10.1007/s11096-012-9614-6. Epub 2012 Feb 14.
After medical center implementation of 2009 ASHP/IDSA guidelines, we evaluated the appropriateness of vancomycin dosing and TDM.
Our primary objectives were to assess short term effects on (1) appropriateness of initial vancomycin dosing, (2) appropriateness of sampling of plasma levels, before and after implementation of guidelines.
The study was conducted in two phases, pre-guideline and post-guideline implementation. The interventions included (1) Nurses and phlebotomist education regarding the appropriate timing of vancomycin sampling, (2) A nomogram for appropriate initial dosing that was distributed to medical staff. Patient demographics, dosing and timing of sampling were collected in eligible patients and assessed for appropriateness.
The appropriateness of the prescribed dose increased from 51% (128/253) of patients during the pre period to 78% (155/200) (p < 0.0001) during the post period. Similarly, overall appropriateness of sampling of vancomycin troughs at steady state improved from 36% (63/173) pre to 55% (106/191) (p < 0.03) post. Specifically, the appropriate timing of troughs (within 30 min of the next dose) increased from 37% (64/173) during the pre period to 78% (149/191) during the post period (p < 0.0001). Conclusion Adoption of the guidelines with associated training resulted in significant short term improvement in vancomycin dosing and TDM.
在医疗中心实施 2009 年 ASHP/IDSA 指南后，我们评估了万古霉素剂量和 TDM 的适宜性。
我们的主要目标是评估（1）初始万古霉素剂量的适宜性，（2）在实施指南前后采样血浆水平的适宜性。
该研究分两个阶段进行，即指南前和指南后实施阶段。干预措施包括（1）护士和采血员接受有关万古霉素采样适当时间的教育，（2）向医务人员分发适当初始剂量的列线图。在合格患者中收集患者人口统计学、剂量和采样时间，并评估其适宜性。
规定剂量的适宜性从预期间的 51%（128/253）患者增加到后期间的 78%（155/200）（p<0.0001）。同样，稳态下万古霉素谷值采样的总体适宜性也从预期间的 36%（63/173）提高到后期间的 55%（106/191）（p<0.03）。具体而言，谷值（在下一次剂量的 30 分钟内）的适当时间从预期间的 37%（64/173）增加到后期间的 78%（149/191）（p<0.0001）。结论：采用指南并进行相关培训导致万古霉素剂量和 TDM 短期内显著改善。
