title: Effectiveness of pharmacy policies designed to limit inappropriate vancomycin use: a population-based assessment.
abstract: OBJECTIVE
  In Oregon in 1994, a population-based study of 66 nonpsychiatric hospitals indicated that 40% of vancomycin orders were inappropriate according to Centers for Disease Control and Prevention guidelines. We repeated the study to determine whether vancomycin use had been affected by pharmacy policies implemented following the 1994 study.
  
  
  METHODS
  We surveyed pharmacists in nonpsychiatric hospitals in Oregon regarding vancomycin use policies in their hospitals. Using pharmacy records, we identified and abstracted the charts of all patients in Oregon hospitals receiving vancomycin during a 3-week period to determine appropriate use of vancomycin.
  
  
  RESULTS
  Thirteen (20%) of 64 hospitals had implemented a vancomycin restriction policy since 1994; none ofthe remaining hospitals in the study had a policy. In 1999, hospitals with vancomycin restriction policies had substantially decreased rates of inappropriate vancomycin use compared with hospitals without such policies (1.0 vs 1.8 orders per 1,000 patient-days; P = .01). Compared with 1994 baseline rates of inappropriate use, hospitals that adopted policies experienced a decrease (from 1.5 orders per 1,000 patient-days in 1994 to 1.0 in 1999; P= .13), whereas hospitals without policies experienced a statistically significant increase (from 0.9 orders per 1,000 patient-days in 1994 to 1.8 in 1999; P= .001). Restriction policies were most effective at reducing rates of inappropriate use for treatment of confirmed gram-positive infections and prophylaxis.
  
  
  CONCLUSIONS
  Vancomycin restriction policies were associated with a decrease in inappropriate therapeutic and prophylactic vancomycin use, but had no effect on inappropriate empiric use. Hospitals considering limits regarding inappropriate use should consider implementation of institution-based vancomycin restriction policies as part of an overall strategy.
authors.affiliation: Division of Applied Public Health Training, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Thomas
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cieslak
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Strausbaugh
authors.forename: David W
authors.initials: DW
authors.lastname: Fleming
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D017723:Drug Utilization Review / Q000458:organization & administration*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000592:standards*; D009922:Oregon; D016134:Organizational Policy; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000592:standards; D017410:Practice Guidelines as Topic; D014481:United States; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin