Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy

Bond, Christopher; Raehl, Cynthia L.

doi:10.2146/ajhp040555

Cited by 99 publications

(75 citation statements)

References 44 publications

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“…14 Effective TDM programs have significantly decreased antimicrobial use and annual hospital costs, as well as improved patient care. [15][16][17] Surprisingly, there is limited pediatric data regarding the practice of vancomycin drug monitoring, with or without the use of antimicrobial stewardship programs. 18 A review article by Bates et al 19 addressed weaknesses of an autonomous pharmacy TDM alone and stressed the importance of a combined approach that incorporates physician behavior modification, autonomous TDM, and computerized physician ordering.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

Suryadevara

Steidl

Probst

et al. 2012

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES The objective of this study was to measure the appropriateness of vancomycin monitoring in a pediatric tertiary care center and to evaluate the effectiveness of two interventions, autonomous pharmacy therapeutic drug monitoring and health care provider education, in reducing avoidable pediatric patient trauma and hospital cost. METHODS A retrospective chart review evaluating vancomycin therapeutic drug monitoring (TDM) in pediatric inpatients was performed before and after the introduction of an autonomous pharmacy TDM program and health care provider (HCP) education. RESULTS Thirty-five patients were included in our study, prior to any intervention. Of these, 9% of patients had trough concentrations appropriately deferred. Of the total of 64 trough concentrations obtained, 94% were considered to be inappropriate. After the start of the autonomous pharmacy TDM program, of the 54 eligible patients (111 troughs), 9% had trough concentrations appropriately deferred, and 34% were inappropriate. In the 3-month period following the introduction of HCP education in combination with pharmacy TDM, we identified 27 eligible patients. Among those, 15% of the patients had trough concentrations appropriately deferred. Of the 43 trough concentrations obtained, only 9% were considered to be inappropriate. The combination of pharmacy TDM with HCP education decreased annualized hospital cost by 60%, from $13,080 to $5232. CONCLUSIONS Inappropriate vancomycin TDM occurs commonly in our institution, resulting in unnecessary hospital cost and patient trauma. The combination of pharmacy TDM and HCP education significantly improved clinical practice; however, results were short-lived. Further interventions, such as computer based order entry, will likely be needed to reinforce and improve long-term TDM practice in pediatric patients.INDEX TERMS antibiotic stewardship, therapeutic drug monitoring, vancomycin J Pediatr Pharmacol Ther 2012;17(2):159-165

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Section: Introductionmentioning

confidence: 99%

Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

Suryadevara

Steidl

Probst

et al. 2012

The Journal of Pediatric Pharmacology and Therapeutics

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“…Pharmacist-managed aminoglycoside, vancomycin, and antiepileptic therapy has been associated with significantly improved economic and clinical outcomes in Medicare patients. 5,6 Impacts in terms of attaining goals of therapy have also been demonstrated, specifically with pharmacist-managed lipid clinics. 7 In the community setting, studies have demonstrated a lack of laboratory monitoring for medications.…”

Section: Résultatsmentioning

confidence: 99%

Implementation and Assessment of a Pharmacy Educational Program Concerning Laboratory Monitoring for Medications

LeBlanc¹,

Cameron-Coffill

Symes

et al. 2017

CJHP

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“…Laboratory charges were 7.80% increased ($22,530,474 in excess charges) and total Medicare charges were 6.30% higher ($34,769,250) (p < 0.0001) compared to hospitals that have pharmacist-managed vancomycin and aminoglycoside therapy. Lastly, in hospitals lacking pharmacist management, there was an excess of $34,769,250 in drug charges [8]. Pharmacists play an important role in achieving and improving patient clinical outcomes and benefiting the health system through multiple cost-savings.…”

Section: Comparative Evaluation Of Pharmacist Managed Vancomycin Dosimentioning

confidence: 99%

Comparative Evaluation of Pharmacist-Managed Vancomycin Dosing in a Community Hospital Following Implementation of a System-Wide Vancomycin Dosing Guideline

Koliha¹,

Falk²,

Patel³

et al. 2017

JPP

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Abstract:Purpose: Evaluate the implementation of a large hospital system vancomycin dosing guideline in a community hospital with pharmacist vancomycin management. Design: Single center, retrospective and prospective quality assessment study. Methods: Pharmacist-managed vancomycin therapy was evaluated pre and post-implementation of a new dosing guideline in a study population of 586 from one community hospital. Results: Of the study population, 274 patients evaluated pre-implementation were compared to 312 patients post-implementation of the large hospital-system guideline (46.8% and 53.2%, respectively). There was no significant difference in demographics between both patient populations. Days of vancomycin therapy was shorter in the post-implementation group (4.32  2.241) versus the pre-implementation group [(4.81  2.764), p = 0.018]. Days to goal trough was longer in the post-implementation group (3.51  1.622) compared to the pre-implementation group [(3.09  2.046), p = 0.054]. A post-hoc regression analysis was conducted, showing that age, days of vancomycin therapy and goal trough are predictors for 77% of cases within the post-implementation group. Conclusion: The implementation of a new vancomycin dosing guideline significantly impacted days of vancomycin therapy and days to goal trough in patients on vancomycin managed by pharmacists. Our results encourage completion of future studies utilizing the regression analysis data, which may impact the future care of patient on vancomycin managed by pharmacists.

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Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy

Abstract: The presence of pharmacist-managed aminoglycoside or vancomycin therapy was associated with significant improvement in health care and economic outcomes for Medicare patients who received these drugs.

Cited by 99 publications

References 44 publications

Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

Implementation and Assessment of a Pharmacy Educational Program Concerning Laboratory Monitoring for Medications

Comparative Evaluation of Pharmacist-Managed Vancomycin Dosing in a Community Hospital Following Implementation of a System-Wide Vancomycin Dosing Guideline

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