Outcomes of a pharmacist‐driven vancomycin monitoring initiative in a community hospital

Abstract

What is known and objective Vancomycin, an antibiotic commonly used to treat MRSA infections, can be nephrotoxic. Administering vancomycin requires close monitoring of serum vancomycin levels and appropriate dosing based on patients’ renal function, underlying infection type and serum concentration levels. This article discusses the results and implications of a pharmacist‐driven vancomycin monitoring initiative, which was implemented at Mercy Catholic Medical Center's Philadelphia Campus (MPC) in July 2016. Methods MPC pharmacists were trained on how to give appropriate vancomycin dosing recommendations based on patients’ vancomycin trough levels, renal function and underlying infection. This retrospective observational study consisted of patients who presented to MPC and were administered vancomycin over a 3‐month period in 2015 for pre‐implementation cohort and over a 3‐month period in 2018 for post‐implementation cohort. Patients with age ≥18 and receiving vancomycin for a minimum of 48 hours were included, whereas ESRD patients were excluded. Primary goal evaluated whether the incidence of AKI decreased with the pharmacist‐driven initiative. Secondary goal assessed whether vancomycin level monitoring and achievement of goal serum levels improved with the initiative. Results and discussion A total of 214 patients were included in the final data analysis, with 110 patients in the pre‐implementation cohort and 104 patients in the post‐implementation cohort. Although not statistically significant, a higher incidence of AKI was observed in the post‐implementation cohort. However, compared to pre‐implementation cohort, post‐implementation group had higher percentage of patients with underlying comorbidities (such as CKD), higher number of cases of severe sepsis and septic shock, and greater number of patients with concomitant exposure to CT contrast and piperacillin‐tazobactam—all of which were confounding factors that likely increased the AKI incidence in post‐implementation cohort. With the initiative, there was a significant increase in the number of patients with appropriate vancomycin trough level monitoring (27.3% vs 55.8%, p value < 0.001) in the post‐implementation cohort and a decrease in the number of patients with no trough level monitoring (30% vs. 7.6%, p value < 0.001). What is new and conclusion Pharmacist‐driven vancomycin monitoring significantly improved the monitoring compliance of vancomycin trough levels. In patients who developed AKI during their hospital course, pharmacist interventions improved the total percentage of patients attaining desired trough goals and helped reduce further renal insult from supratherapeutic vancomycin level. Incorporation of AUC‐guided dosing and monitoring has the potential to further optimize vancomycin efficacy and safety.

Using Japanese big data to investigate novel factors and their high‐risk combinations that affect vancomycin‐induced nephrotoxicity

“…23 As a result, these proportions were 3.92% (2 out of 51) and 11.9% (337 out of 2823), respectively; thus, the developmental impact of TDM guideline could not be evaluated due to the small sample size. Since most Japanese reports on the contribution of ward pharmacists were published after 2013, [41][42][43][44] the change in contributions over time needs to be verified.…”

“…This conclusion is reliable because the proportions of VIN were lower in patients with ward pharmacy service before and after propensity score matching. Ward pharmacists foster the appropriate use of VCM by monitoring VIN, making TDM recommendations and setting doses 41–44 . As most of the screened studies were single‐centre, institutional bias could not be entirely avoided.…”

“…Ward pharmacists foster the appropriate use of VCM by monitoring VIN, making TDM recommendations and setting doses. [41][42][43][44] As most of the screened studies were single-centre, institutional bias could not be entirely avoided. Although the medical fee calculation requirements related to ward pharmacy services include setting and evaluating drug dosages, 17,26 we could not clearly show which interventions…”

Implementation, utilization, and evaluation of a pharmacist-driven romiplostim dosing service for patients with immune thrombocytopenia at a multisite cancer centre

“…While pharmacist dosing services are commonplace in health-system pharmacy with frequently used medications that require therapeutic drug monitoring, such as vancomycin, aminoglycosides, and warfarin, dosing services for less frequently used drugs is uncommon. [7][8][9][10] Romiplostim is indicated for the treatment of ITP, which is a relatively rare condition with an annual incidence of 2 to 5 cases per 100,000 per year in the general population. 2 Our service is particularly novel, in that it represents the first pharmacist-driven dosing service for romiplostim or for any medication for ITP in the known published literature, to the best of our knowledge.…”

Therapeutic drug monitoring of free vancomycin concentration in practice: A new analytical technique based on the HFCF–UF sample separation method

“…It is the first‐line therapeutic drug for methicillin‐resistant Staphylococcus aureus (MRSA) infection. It is generally used to treat pneumococcal bacteremia, endocarditis and meningitis caused by MRSA infection (Joseph et al, 2021; Masse et al, 2020; Shenep et al, 1988). However, vancomycin has adverse reactions such as anaphylaxis, nephrotoxicity, ototoxicity, phlebiti, and agranulocytosis (Alvarez‐Arango et al, 2021; Peng et al, 2020).…”