Vancomycin control measures at a tertiary-care hospital: impact of interventions on volume and patterns of use.
OBJECTIVE
Evaluate vancomycin prescribing patterns in a tertiary-care hospital before and after interventions to decrease vancomycin utilization.


METHODS
Before/after analysis of interventions to limit vancomycin use.


METHODS
420-bed academic tertiary-care center.


METHODS
Educational efforts began August 10, 1994, and involved lectures to medical house staff followed by mailings to all physicians and posting of guidelines for vancomycin use on hospital information systems. Active interventions began November 15, 1994, and included automatic stop orders for vancomycin at 72 hours, alerts attached to the medical record, and, for 2 weeks only, computer alerts to physicians following each vancomycin order. Parenteral vancomycin use was estimated from the hospital pharmacy database of all medication orders. Records of a random sample of 344 patients receiving vancomycin between May 1, 1994, and April 30, 1995, were reviewed for an indication meeting published guidelines.


RESULTS
Vancomycin prescribing decreased by 22% following interventions, from 8.5 to 6.8 courses per 100 discharges (P<.05). The estimated proportion of vancomycin ordered for an indication meeting published guidelines was 36.6% overall, with no significant change following interventions. However, during the 2 weeks that computer alerts were in place, 60% of vancomycin use was for an approved indication.


CONCLUSIONS
Parenteral vancomycin prescribing decreased significantly following interventions, but the majority of orders still were not for an indication meeting published guidelines. Further improvement in the appropriateness of vancomycin prescribing potentially could be accomplished by more aggressive interventions, such as computer alerts, or by targeting specific aspects of prescribing patterns.
Singer
M V
MV
Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Haft
R
R
Barlam
T
T
Aronson
M
M
Shafer
A
A
Sands
K E
KE
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001900:Boston; D017723:Drug Utilization Review; D019983:Guideline Adherence; D006745:Hospital Bed Capacity, 300 to 499; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008505:Medical Staff, Hospital / Q000193:education*; D017410:Practice Guidelines as Topic; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin