title: Vancomycin administration: the impact of multidisciplinary interventions.
abstract: BACKGROUND
  The clinical microbiology team observed that patients were not receiving all prescribed doses of vancomycin. Ward staff was confused about ordering and interpreting vancomycin therapeutic drug monitoring (TDM) levels.
  
  
  OBJECTIVE
  To audit the incidence of vancomycin dose omission. To implement a series of interventions to improve vancomycin dose administration, and to repeat the audit process to assess these interventions.
  
  
  METHODS
  Three prospective audits were conducted to assess the impact of vancomycin TDM on administration of vancomycin. After the first audit, a number of changes in the TDM process were undertaken. After review of the second audit, a senior pharmacist coordinated ward-based pharmacists in assisting staff to interpret levels, and TDM interpretative charts were designed for drug charts. Following the third audit, feedback to hospital management and a plan for ongoing education were undertaken.
  
  
  RESULTS
  There was a significant reduction in the number of vancomycin doses held inappropriately in the third (10% (78/782) of prescribed doses) when compared to the first audit (16% (161/1007) of doses) (p<0.01). Of doses that were held inappropriately, there was a significant decrease in doses held for no apparent reason in audit 3 (16% (27/170) of prescribed doses) when compared to audit 1 (25% (69/282) of doses) (p<0.05).
  
  
  CONCLUSIONS
  The interventions resulted in a 37.5% reduction in inappropriately held vancomycin doses over a one-year period; 10% of doses are still being held inappropriately. This study highlights the difficulties in identifying barriers to change and changing healthcare worker behaviour.
authors.affiliation: Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland. rachelcrowley@beaumont.ie
authors.forename: R K
authors.initials: RK
authors.lastname: Crowley
authors.forename: F
authors.initials: F
authors.lastname: Fitzpatrick
authors.forename: D
authors.initials: D
authors.lastname: Solanki
authors.forename: S
authors.initials: S
authors.lastname: FitzGerald
authors.forename: H
authors.initials: H
authors.lastname: Humphreys
authors.forename: E G
authors.initials: EG
authors.lastname: Smyth
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D002983:Clinical Competence; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods / Q000592:standards*; D004360:Drug Therapy, Computer-Assisted / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007494:Ireland; D008485:Medical Audit; D010348:Patient Care Team; D010607:Pharmacy Service, Hospital; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin