Improving the appropriateness of vancomycin use by sequential interventions.
BACKGROUND
Vancomycin usage is directly associated with the incidence of vancomycin-resistant enterococci. Optimal methods to reduce inappropriate use have not been delineated. We determined the appropriateness of vancomycin prescribing at our hospital on the basis of national guidelines and assessed the effect of sequential administrative and educational interventions.


METHODS
In this prospective 3-phase study conducted in a Veterans Affairs Medical Center, we monitored vancomycin prescribing at baseline and in 2 follow-up periods. Administrative interventions included discussions with service chiefs and revising routine perioperative antibiotic prophylaxis orders. Educational interventions included in-services about vancomycin-resistant enterococci and appropriate vancomycin prescribing. In each monitoring period, 50 consecutive new vancomycin orders that could be evaluated were classified for appropriateness and categorized by indication.


RESULTS
At baseline, 70% of vancomycin use was inappropriate. Surgical services accounted for 84% of orders. Interventions targeted services with high or frequently inappropriate vancomycin use. After administrative interventions, inappropriate vancomycin use dropped to 40% of orders (P =.003). Improvements were noted in targeted services. Educational interventions further decreased inappropriate vancomycin use, but the effect appeared transient.


CONCLUSIONS
The simple, nonrestrictive administrative interventions used resulted in a statistically significant (30%) reduction in inappropriate vancomycin prescribing. However, educational interventions provided only transient benefit on institutional prescribing patterns.
Lipsky
B A
BA
Veterans Affairs Puget Sound Health Care System, and the Department of Medicine, University of Washington, Seattle 98108-1532, USA.
Baker
C A
CA
McDonald
L L
LL
Suzuki
N T
NT
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015986:Confounding Factors, Epidemiologic; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review / Q000592:standards*; D006300:Health Services Misuse; D006748:Hospital Departments / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D011446:Prospective Studies; D013997:Time Factors; D014640:Vancomycin / Q000627:therapeutic use*; D014861:Washington
D000900:Anti-Bacterial Agents; D014640:Vancomycin