460. Shut Off Vancomycin Early (SHOVE) Program
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Vancomycin (VANC) has been increasingly recommended as early empiric therapy for presumed methicillin resistant Staphylococcus aureus (MRSA) infections. Subsequently VANC is empirically started in many patients without MRSA infections and continued when no documentation of MRSA infection or other Gram positive organism that would require therapy. The new antimicrobial team (AMT), which consisted of an infectious disease physician and clinical pharmacists initated the SHOVE program to target VANC usage at day 3 after starting therapy when cultures have returned to ensure that it was discontinued if there was no MRSA or other significant Gram positive infection requiring VANC.
Methods: A review of the AMT pharmacy intervention database from the programs inception to now (1/09 to 4/09) reviewing the SHOVE interventions. We evaluated our impact on VANC usage and compared it to a 3 month period before the AMT and SHOVE implementation. We also evaluated whether our recommendations were accepted by teams and its impact on VANC usage when MRSA was not present and the impact on length of VANC usage.
Results: A total of 94 patients who were started on VANC were evaluated. 43 were in SHOVE and 51 before the program implementation. Empiric VANC was started in 87.5% patients with 26% having documented MRSA or Gram positive infection needing VANC with the remaining 74% not requiring VANC at day 3. 26 of 43 (60%) clinical teams accepted discontinuation of VANC when requested at day 3. When MRSA was not present, the mean duration of VANC usage, was 2.5 days in the accepted intervention group vs 8.6 days when they did not accept the recommendation (P<0.001) in the SHOVE program. Comparing overall VANC usage pre vs post SHOVE, showed an overall decrease from 6.27 to 3 days (P= 0.046) and 2 less VANC troughs per patient. There were no new MRSA infections in the intervention group who had early discontinuation.
Conclusion: The development of a SHOVE program by a hospital AMT to specifically target empiric VANC discontinuation at 3 days when MRSA is not cultured resulted in significant reductions in VANC usage without emergence of MRSA. This type of program could impact savings on drug utilization and VANC troughs within a hospital system.
Graeme Forrest, MBBS1, Nathan Johnson, Pharm D2, Heather Norvelle, PharmD2, Jessica Steffl, Pharm D2, Jerusha Taylor, Pharm D2 and  J. Taylor, None..
N. Johnson, None..
J. Steffl, None..
H. Norvelle, None. 
G. Forrest,
AdvanDx Role(s): Investigator, Scientific Advisor (Review Panel or Advisory Committee), Received: Speaker Honorarium.
Cubist Role(s): Research Relationship, Received: Research Support., (1)Portland VA Medical Center, Portland, OR, (2)OHSU, Portland, OR