Methods: A presentation regarding vancomycin monitoring and dosing was delivered to pediatric house staff. They were asked to complete pre- and post-intervention surveys regarding their comfort level with vancomycin monitoring and dose adjustment. Charts from the pediatric inpatient floors and ICU were reviewed 6 months before and after the intervention. Data collected included timing of baseline creatinine and vancomycin troughs as well as dose adjustments.
Results: 22 pre- and 17 post-test surveys were completed. 5% of residents reported comfort adjusting vancomycin doses based on subtherapeutic troughs on the pre-test vs 100% on the post-test. 73% felt comfortable adjusting doses based on supratherapeutic troughs pre- vs 97% post-test (p<0.05).
115 patients pre- and 92 patients post-intervention were included in our analysis. Baseline creatinine levels were obtained in 87% of patients pre- vs 100% post-intervention (p<0.0003). Vancomycin troughs were obtained at the correct time in 65% of patients pre- vs 87% post-intervention (p<0.002). Pre-intervention, 83% of patients with subtherapeutic troughs had their doses changed appropriately vs 90% post-intervention (p<0.37). Of the 5 patients with supratherapeutic troughs (>20), 60% had their next dose held appropriately pre- vs 80% post-intervention (p=1).
Conclusion: Our data suggest a statistically significant improvement in obtaining baseline creatinine levels and vancomycin troughs at appropriate times. There is no significant difference between dose adjustment based on troughs pre- and post- intervention. We will continue our educational intervention every 6 months in order to sustain its impact.