Hammond Drayton A, Atkinson Lexis N, James Taylor B, Painter Jacob T, Lusardi Katherine
PharmD, MBA, BCPS, BCCCP. Assistant Professor. Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences; & Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center. Little Rock, AR (United States).
Pharmacy Resident. Department of Pharmacy, Central Arkansas Veterans Healthcare System. Little Rock, AR (United States).
Pharm Pract (Granada). 2017 Apr-Jun;15(2):949. doi: 10.18549/PharmPract.2017.02.949. Epub 2017 Jun 30.
Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin.
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.
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.
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.
Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.
许多机构都有关于万古霉素起始用药及监测的指南，但未提及用药时间。
我们的目的是评估在一项改变病房患者万古霉素给药剂量和谷浓度采集时间的倡议前后，万古霉素谷浓度采集的适宜性。
对2014年5月至2016年接受定期静脉注射万古霉素的病房患者进行回顾性队列研究。护士经理和药剂师对工作人员进行了培训。采用学生t检验比较干预前后连续数据组间差异，采用卡方检验比较分类数据组间差异。
干预前（n = 124）和干预后（n = 122）组的基线特征相似，但基于体重的维持剂量（15.3 mg/kg对16.5 mg/kg，p = 0.03）以及早晨采集血样时采集谷浓度的百分比（14%对87%，p < 0.001）除外。干预前和干预后组患者接受负荷剂量的频率相似（14.5%对16%，p = 0.68）。在距下次给药预定时间30分钟（40%对42%，p = 0.72）、60分钟（57%对63%，p = 0.35）或75分钟（60%对68%，p = 0.22）时，适宜采集万古霉素谷浓度的百分比无显著差异。
工作人员培训以及将万古霉素谷浓度采集与早晨采血标准化并未影响适宜采集万古霉素谷浓度的百分比。
