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Vancomycin Control Measures at a Tertiary-Care Hospital: Impact of Interventions on Volume and Patterns of use

Published online by Cambridge University Press:  02 January 2015

Mary V. Singer ,
Rachel Haft ,
Tamar Barlam ,
Mark Aronson ,
Amy Shafer  and
Kenneth E. Sands
Mary V. Singer
Affiliation:
Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Rachel Haft
Affiliation:
Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Tamar Barlam
Affiliation:
Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Mark Aronson
Affiliation:
Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Amy Shafer
Affiliation:
Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Kenneth E. Sands*
Affiliation:
Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
*
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
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Abstract

OBJECTIVE: Evaluate vancomycin prescribing patterns in a tertiary-care hospital before and after interventions to decrease vancomycin utilization.

DESIGN: Before/after analysis of interventions to limit vancomycin use.

SETTING: 420-bed academic tertiary-care center.

INTERVENTIONS: Educational efforts began August 10, 1994, and involved lectures to medical house staff followed by mailings to all physicians and posting of guidelines for vancomycin use on hospital information systems. Active interventions began November 15, 1994, and included automatic stop orders for vancomycin at 72 hours, alerts attached to the medical record, and, for 2 weeks only, computer alerts to physicians following each vancomycin order. Parenteral vancomycin use was estimated from the hospital pharmacy database of all medication orders. Records of a random sample of 344 patients receiving van-comycin between May 1, 1994, and April 30, 1995, were reviewed for an indication meeting published guidelines.

RESULTS: Vancomycin prescribing decreased by 22% following interventions, from 8.5 to 6.8 courses per 100 discharges (P<.05). The estimated proportion of van-comycin ordered for an indication meeting published guidelines was 36.6% overall, with no significant change following interventions. However, during the 2 weeks that computer alerts were in place, 60% of vancomycin use was for an approved indication.

CONCLUSIONS: Parenteral vancomycin prescribing decreased significantly following interventions, but the majority of orders still were not for an indication meeting published guidelines. Further improvement in the appropriateness of vancomycin prescribing potentially could be accomplished by more aggressive interventions, such as computer alerts, or by targeting specific aspects of prescribingpatterns.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 4 , April 1998 , pp. 248 - 253
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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