title: Impact of a Pharmacist-Initiated Vancomycin Monitoring Program.
abstract: OBJECTIVE
  Evaluate the clinical impact of pharmacist-initiated vancomycin monitoring and dosing in a long-term care setting.
  
  
  METHODS
  Single-center, pretest, post-test design.
  
  
  METHODS
  Rutland Nursing Home, Brooklyn, New York.
  
  
  METHODS
  Nursing facility residents treated with intravenous vancomycin (N = 198).
  
  
  METHODS
  The primary objective is to determine the incidence of acute kidney injury (AKI) a year before and a year after implementation of a pharmacist-initiated vancomycin-monitoring protocol. The secondary objectives are percentage of serum drug levels in therapeutic range and compliance with laboratory testing for monitoring of nephrotoxicity.
  
  
  RESULTS
  The overall incidence of AKI decreased from 16.3% (8/49) to 4.7% (7/149) (P = 0.013). Compliance with weekly monitoring for nephrotoxicity via serum creatinine and blood urea nitrogen improved from 76% (37/49) to 95% (141/149) (P ≤ 0.001). Compliance with weekly vancomycin level monitoring improved from 71% (35/49) to 85% (126/149) (P = 0.041). Percentage of vancomycin trough levels in the therapeutic range of 10-20 mcg/mL were shown to have no difference between two groups, but vancomycin levels > 20 mcg/mL decreased from 31% (15/49) to 17% (26/149) (P = 0.048).
  
  
  CONCLUSIONS
  Implementation of pharmacist-driven vancomycin monitoring significantly improved monitoring compliance of vancomycin serum levels and kidney function as well as reduced the incidence of AKI in the long-term care setting.
authors.affiliation: New York Presbyterian / Weill Cornell Medical Center, New York, New York, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Smith
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Millares-Sipin
authors.forename: Marian
authors.initials: M
authors.lastname: James
authors.forename: Henry
authors.initials: H
authors.lastname: Cohen
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration*; D016730:Program Development; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003404:Creatinine