药物警戒杂志

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The Impact of Pharmacist Led Vancomycin Order Set Implementation in a Computerized-Prescriber-Order-Entry (CPOE) System at a Tertiary Care Centre: A Quasi Experimental Study

Nader Damfu, Mohammed Aseeri, Allahna Davis, Hani Hasan and Sherine Ismail

Introduction: Our hospital has developed a vancomycin protocol in order to improve vancomycin dosing and prevent improper sampling time of vancomycin levels and treatment failure. The study objective is to evaluate the impact of implementing a vancomycin order set integrated into a Computerized-Prescriber-Order-Entry (CPOE) system by pharmacist in adult surgical wards to optimize vancomycin dosing and monitoring.

Primary objective: Evaluation of the correct sampling time of vancomycin trough levels by implementing a vancomycin order set guiding nurses and physicians on the appropriate sampling time.

Secondary objectives: Evaluation of the impact of vancomycin order set integrated into CPOE system on vancomycin initial doses, appropriate use based on indication and time to reach target therapeutic level.

Method: This study was a prospective quasi-experimental study. Patients who are >18 years, admitted to surgical wards, receiving new vancomycin orders, creatinine clearance ≥15 ml/min and weighing 40-120 kg were eligible. We excluded patients receiving vancomycin loading doses, prophylaxis, treatment course <5 days and random or peak vancomycin levels. Educational sessions were provided to the surgical residents on the use the order set by pharmacy resident, subsequently vancomycin orders were then reassessed after the order set implementation.

Results: Total of 272 vancomycin trough levels were collected (136 levels in the pre-phase and 136 levels in the post-implementation phase) from 33 patients who met the study eligibility criteria. A 10% reduction in inappropriate vancomycin trough levels in the post-implementation phase was observed compared to the pre-phase (p=0.478) Appropriate vancomycin initial doses for the study patients were 2 out of 11 doses (18%) in the pre-phase and 22 doses in the post-phase (50%) (p=0.078).

Conclusion: The implementation of an institutional vancomycin order set did not result in a significant change in appropriate vancomycin initial dosing and trough level sampling time in the adult surgical wards in our hospital.