Knack Olivia C, Landayan Alice M, Williams Kelsey N, Amaya Lee M, Gauthier Timothy P
Clinical Pharmacy Enterprise, Baptist Health South Florida, Miami, Florida.
Department of Pharmacy, Baptist Health South Miami Hospital, Miami, Florida.
Antimicrob Steward Healthc Epidemiol. 2023 Mar 15;3(1):e51. doi: 10.1017/ash.2022.376. eCollection 2023.
We sought to determine the value of an audit-and-feedback monitoring method in facilitating meaningful practice changes to improve vancomycin dosing and monitoring.
Retrospective, multicenter, before-and-after implementation observational quality assurance initiative.
The study was conducted in 7 not-for-profit, acute-care hospitals within a health system in southern Florida.
The preimplementation period (September 1, 2019, through August 31, 2020) was compared to the postimplementation period (September 1, 2020, through May 31, 2022). All vancomycin serum-level results were screened for inclusion. The primary end point was the rate of fallout, defined as vancomycin serum level ≥25 µg/mL with acute kidney injury (AKI) and off-protocol dosing and monitoring. Secondary end points included the rate of fallout with respect to AKI severity, rate of vancomycin serum levels ≥25 µg/mL, and average number of serum-level evaluations per unique vancomycin patient.
In total, 27,611 vancomycin levels were analyzed from 13,910 unique patients. There were 2,209 vancomycin serum levels ≥25 µg/mL (8%) among 1,652 unique patients (11.9%). AKI was identified in 379 unique patients (23%) with a vancomycin levels ≥25 µg/mL. In total, 60 fallouts (35.2%) occurred in the 12-month preimplementation period (∼5 per month) and 41 fallouts (19.6%) occurred in the 21-month postimplementation period (∼2 per month; = .0006). Failure was the most common AKI severity in both periods (risk: 35% vs 24.3%, = .25; injury: 28.3% vs 19.5%, = .30; failure: 36.7% vs 56%, = .053). Overall, the number of evaluations of vancomycin serum levels per unique patient remained consistent throughout both periods (2 vs 2; = .53).
Implementation of a monthly quality assurance tool for elevated outlier vancomycin levels can improve dosing and monitoring practices resulting in enhanced patient safety.
我们试图确定一种审核与反馈监测方法在促进有意义的实践改变以改善万古霉素给药和监测方面的价值。
回顾性、多中心、实施前后观察性质量保证倡议。
该研究在佛罗里达州南部一个医疗系统内的7家非营利性急症护理医院进行。
将实施前阶段（2019年9月1日至2020年8月31日）与实施后阶段（2020年9月1日至2022年5月31日）进行比较。筛选所有万古霉素血清水平结果以纳入研究。主要终点是不良事件发生率，定义为万古霉素血清水平≥25µg/mL且伴有急性肾损伤（AKI）以及未按方案给药和监测。次要终点包括与AKI严重程度相关的不良事件发生率、万古霉素血清水平≥25µg/mL的发生率以及每位使用万古霉素的独特患者血清水平评估的平均次数。
共分析了13910例独特患者的27611份万古霉素水平。在1652例独特患者（11.9%）中，有2209份万古霉素血清水平≥25µg/mL（8%）。在379例万古霉素水平≥25µg/mL的独特患者（23%）中发现了AKI。在实施前的12个月期间共发生60例不良事件（35.2%）（每月约5例），在实施后的21个月期间发生41例不良事件（19.6%）（每月约2例；P = 0.0006）。两个阶段中最常见的AKI严重程度均为衰竭（风险：35%对24.3%，P = 0.25；损伤：28.3%对19.5%，P = 0.30；衰竭：36.7%对56%，P = 0.053）。总体而言，两个阶段中每位独特患者的万古霉素血清水平评估次数保持一致（2次对2次；P = 0.53）。
实施针对异常升高的万古霉素水平的月度质量保证工具可改善给药和监测实践，从而提高患者安全性。
