Letter to the Editor

An educational intervention to improve vancomycin prescribing and monitoring

Despite vancomycin being in use for over half-a-century, it is still not dosed or monitored appropriately in many centers around the world. The objective of this study was to determine the effectiveness of a multifaceted intervention to implement a vancomycin dosing and monitoring guideline across multiple medical and surgical units over time.

This was an observational before-and-after interventional cohort study. The pre-intervention period was August to December 2010–2011 and the post-intervention period was September to November 2012–2014. The implementation strategy comprised: face-to-face education, online continuing medical education, dissemination of pocket guideline and email reminder. Outcome measures included: appropriate prescribing of loading and maintenance doses, therapeutic drug monitoring, time to attain target range and nephrotoxicity.

Post-implementation prescribing of loading doses increased (10.4%–43.6%, P=<0.001), guideline adherent first maintenance dose (44%–68.4% P = 0.04), correct dose adjustment from (53.1%–72.2%, P = 0.009). Beneficial effects pre and post-implementation were observed for adherent timing of initial concentration (43.2%–51.9%, P = 0.01), concentrations in target range (32.6%–44.1%, P = 0.001), time to target range (median 6–4 days, P=<0.001), potentially nephrotoxic concentrations (30.7%–20.9%, P=<0.001) and nephrotoxicity (10.4%–6.8%, P=<0.001).

A multifaceted intervention to implement a vancomycin dosing and monitoring guideline significantly improved prescribing, monitoring, pharmacokinetic and safety outcomes for patients treated with vancomycin over an extended period. However, increased guideline adoption by clinicians is required to maximize and prolong the utility of this important agent.