Vancomycin in Oregon: who's using it and why.
OBJECTIVE
To determine the proportion of vancomycin orders that are appropriate according to national guidelines and to identify targets for educational messages.


METHODS
Population-based study of vancomycin use in Oregon during a 3-week period. Survey of pharmacists, prospective flagging of vancomycin orders, and data abstraction from patient charts using standardized forms.


METHODS
Nonpsychiatric hospitals in Oregon.


RESULTS
Four (6%) of the 66 Oregon hospitals had pharmacy restrictions on initial vancomycin orders. Sixty-four (97%) of the hospitals participated in the study of indications for use; 293 vancomycin orders were reported; 3.8 courses were initiated per 1,000 patient-days. Indications for use were determined for 266 (91%); of these, 159 (60%) were deemed appropriate. Of uses for prophylaxis, empirical treatment of suspected gram-positive infection, and treatment of documented gram-positive infection, 57%, 56%, and 65%, respectively, were appropriate. Of hospitals with <250, 251-475, and >475 licensed beds, 65%, 58%, and 57% of vancomycin orders were appropriate. No single medical specialty accounted for >16% of inappropriate vancomycin use.


CONCLUSIONS
Vancomycin was used inappropriately by physicians of many different specialties, in hospitals of all sizes, and in sundry clinical situations. The problem of inappropriate vancomycin use does not lend itself to solution by educational strategies targeted at specific subgroups; restrictions by hospital pharmacies may be required.
Cieslak
P R
PR
Division of Applied Public Health Training, State Branch, Portland, Oregon, USA.
Strausbaugh
L J
LJ
Fleming
D W
DW
Ling
J M
JM
D000900:Anti-Bacterial Agents; D003428:Cross Infection / Q000517:prevention & control; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D019983:Guideline Adherence; D006801:Humans; D010607:Pharmacy Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin