A vancomycin monitoring program at a community hospital.
BACKGROUND
Because of concern about patients' increased risk of developing resistance to vancomycin, a vancomycin monitoring program involving education, not restriction, on the prudent use of vancomycin was developed at the Barnes-Jewish Christian (BJC) North Region hospitals in St Louis. The program was spearheaded by the pharmacy department and monitored by interdisciplinary committees within the hospital.


METHODS
An educational note based on a Centers for Disease Control and Prevention (CDC) guideline for prudent use of vancomycin was prepared and placed in patient charts by a designated pharmacist. This intervention was tracked along with the medical staff's response to the note. In a one-year period, the rate of appropriate use of vancomycin increased from 59% to 80% (p < 0.01), whereas the number of care interventions involving vancomycin usage decreased by approximately 75%.


CONCLUSIONS
A community hospital can promote appropriate use of antibiotics, in this case vancomycin. The fact that the rate at which vancomycin was appropriately prescribed increased and the number of pharmacist interventions (notes) decreased suggests that the vancomycin note reminders and related educational material were successful. Although these numbers do not represent 100% compliance, treatment with vancomycin may have been clinically appropriate for some of the cases even if the situation was not listed as an appropriate use in the CDC guideline.


CONCLUSIONS
The vancomycin monitoring program, which represents a simple means of intervening and maintaining continuous monitoring and quality improvement in a clinical area, continues at the BJC North Region hospitals.
Clinical Pharmacy Services, Barnes-Jewish Christian (BJC) North Region, St Louis, USA. goecknerb@m7.sprynet.com
B J
BJ
Goeckner
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Hendershot
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Scott
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Drake
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D019983:Guideline Adherence; D006764:Hospitals, Community; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education*; D008923:Missouri; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D017749:Total Quality Management; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin