Sustained improvement in vancomycin dosing and monitoring post-implementation of guidelines: Results of a three-year follow-up after a multifaceted intervention in an Australian teaching hospital

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dc.contributor.author Phillips, Cameron J en_US
dc.contributor.author McKinnon, Ross A en_US
dc.contributor.author Woodman, Richard John en_US
dc.contributor.author Gordon, David Llewellyn en_US
dc.date.accessioned 2019-03-14T02:22:22Z
dc.date.available 2019-03-14T02:22:22Z
dc.date.issued 2018-02
dc.description Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ en_US
dc.description.abstract Introduction 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. Methods 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. Results 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). Conclusions 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. en_US
dc.identifier.citation Phillips, C. J., McKinnon, R. A., Woodman, R. J., & Gordon, D. L. (2018). Sustained improvement in vancomycin dosing and monitoring post-implementation of guidelines: Results of a three-year follow-up after a multifaceted intervention in an Australian teaching hospital. Journal of Infection and Chemotherapy, 24(2), 103–109. https://doi.org/10.1016/j.jiac.2017.09.010 en_US
dc.identifier.doi https://doi.org/10.1016/j.jiac.2017.09.010 en_US
dc.identifier.issn 1341.-321X
dc.identifier.uri http://hdl.handle.net/2328/39104
dc.language.iso en en_US
dc.oaire.license.condition.license CC-BY-NC-ND
dc.publisher Elsevier en_US
dc.relation http://purl.org/au-research/grants/nhmrc/1035960 en_US
dc.relation.grantnumber NHMRC/1035960 en_US
dc.rights Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. en_US
dc.rights.holder Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. en_US
dc.subject Education en_US
dc.subject Guideline en_US
dc.subject Intervention en_US
dc.subject Therapeutic drug monitoring en_US
dc.subject Vancomycin en_US
dc.title Sustained improvement in vancomycin dosing and monitoring post-implementation of guidelines: Results of a three-year follow-up after a multifaceted intervention in an Australian teaching hospital en_US
dc.type Article en_US
local.contributor.authorOrcidLookup Phillips, Cameron J: https://orcid.org/0000-0003-0801-3802 en_US
local.contributor.authorOrcidLookup McKinnon, Ross A: https://orcid.org/0000-0002-3725-793X en_US
local.contributor.authorOrcidLookup Gordon, David Llewellyn: https://orcid.org/0000-0003-3276-9685 en_US
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