An Educational Intervention to Improve the Use and Monitoring of Vancomycin in Pediatric Patients

Background: In 2009, recommendations for monitoring vancomycin were published based on consensus from the American Society of Health-System Pharmacists, the Infectious Disease Society of America and the Society of Infectious Diseases Pharmacists. We have observed variable adherence to these recommendations at Kravis Children’s Hospital at Mount Sinai, in part, due to a gap in knowledge by our pediatric residents regarding appropriate monitoring and dose adjustment in response to vancomycin trough levels. We aim to improve guideline adherence through an educational intervention.

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.