Methods: A quality improvement (QI) initiative based on the Institute for Healthcare Improvement Model was utilized, testing change through Plan-Do-Study-Act (PDSA) cycles. In PDSA Cycle 1, pharmacists designed and implemented a standardized vancomycin dosing protocol for pediatric patients. In PDSA Cycle 2, the addition of area under the curve (AUC)-guided dosing was implemented in select patients. Process and balancing measures included percentage of appropriately drawn vancomycin troughs, provider adherence to the new dosing protocol, and incidence of supratherapeutic troughs.
Results: A total of 32 pediatric patients were assessed. Compared to baseline data, percentage of patients achieving initial therapeutic troughs increased from 35% to 44% and percentage of patients achieving therapeutic troughs within 3 days increased from 67% to 92%. The incidence of supratherapeutic troughs decreased from 10% to 0% and the incidence of vancomycin-associated nephrotoxicity was maintained at 0%.
Conclusion: Standardized initial vancomycin dosing with increased pharmacy involvement led to more patients achieving initial therapeutic troughs, shorter times to therapeutic troughs, and a reduction in supratherapeutic troughs. Next steps include hospital-wide implementation of a pediatric vancomycin per pharmacy protocol.
C. Farrell, None
M. Mancuso, None
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