title: Implementation of the systems approach to improve a pharmacist-managed vancomycin dosing service.
abstract: OBJECTIVE
  Quality improvements achieved by applying the systems approach to assess the clinical effectiveness, operational efficiency, and financial feasibility of a pharmacist-managed vancomycin dosing service are described.
  
  
  CONCLUSIONS
  Faced with increased patient volumes and resource demands, the pharmacy department at Tufts Medical Center conducted an evaluation of its adult inpatient vancomycin dosing service using the systems approach, which emphasizes multidisciplinary assessment of system inputs, processes, and outcomes and consensus-building methods to identify needed changes and recommended action steps. A multidisciplinary committee composed of representatives of the medical center's pharmacy, internal medicine, infectious diseases, nursing, phlebotomy, and clinical laboratory services was assembled; in a series of three moderated monthly sessions, committee members deliberated and ultimately reached consensus on a list of action items. Relative to a concurrent intradepartmental assessment of the vancomycin dosing service based solely on pharmacist feedback, the systems approach identified a greater number and wider array of needed improvements in key program areas. Quality improvements implemented as a direct result of the systems-based analysis included a policy change authorizing pharmacists to order serum vancomycin determinations without physician cosignature and inclusion of a vancomycin dosing algorithm in the institutional antibiotic dosing guide. Future changes based on deliverable action items will result in a structured process to help direct program resources toward the patients most in need of pharmacist-managed vancomycin dosing services.
  
  
  CONCLUSIONS
  The systems approach allowed for a comprehensive multidisciplinary evaluation of the service, as indicated by the identification of process improvements not identified by the department of pharmacy alone.
authors.affiliation: David J. Gagnon, Pharm.D., is Postgraduate Year 2 Resident-Critical Care, Department of Pharmacy, Maine Medical Center, Portland; at the time of writing, he was Postgraduate Year 1 Pharmacy Practice Resident, Department of Pharmacy, Tufts Medical Center, Boston, MA. Russel Roberts, Pharm.D., is Senior Clinical Pharmacy Specialist-Medical Intensive Care Unit, Department of Pharmacy, Tufts Medical Center. Lynne Sylvia, Pharm.D., is Senior Clinical Pharmacy Specialist-Cardiology, Department of Pharmacy, Tufts Medical Center, and Clinical Professor, School of Pharmacy, Northeastern University, Boston. dgagnon@mmc.org.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gagnon
authors.affiliation: David J. Gagnon, Pharm.D., is Postgraduate Year 2 Resident-Critical Care, Department of Pharmacy, Maine Medical Center, Portland; at the time of writing, he was Postgraduate Year 1 Pharmacy Practice Resident, Department of Pharmacy, Tufts Medical Center, Boston, MA. Russel Roberts, Pharm.D., is Senior Clinical Pharmacy Specialist-Medical Intensive Care Unit, Department of Pharmacy, Tufts Medical Center. Lynne Sylvia, Pharm.D., is Senior Clinical Pharmacy Specialist-Cardiology, Department of Pharmacy, Tufts Medical Center, and Clinical Professor, School of Pharmacy, Northeastern University, Boston.
authors.forename: Russel
authors.initials: R
authors.lastname: Roberts
authors.affiliation: David J. Gagnon, Pharm.D., is Postgraduate Year 2 Resident-Critical Care, Department of Pharmacy, Maine Medical Center, Portland; at the time of writing, he was Postgraduate Year 1 Pharmacy Practice Resident, Department of Pharmacy, Tufts Medical Center, Boston, MA. Russel Roberts, Pharm.D., is Senior Clinical Pharmacy Specialist-Medical Intensive Care Unit, Department of Pharmacy, Tufts Medical Center. Lynne Sylvia, Pharm.D., is Senior Clinical Pharmacy Specialist-Cardiology, Department of Pharmacy, Tufts Medical Center, and Clinical Professor, School of Pharmacy, Northeastern University, Boston.
authors.forename: Lynne
authors.initials: L
authors.lastname: Sylvia
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010606:Pharmacy and Therapeutics Committee / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin