Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Leong, Chee Loon; Buising, Kirsty; Richards, Michael J.; Robertson, M.; Street, and A.

doi:10.1111/j.1445-5994.2006.01002.x

Cited by 35 publications

(36 citation statements)

References 18 publications

(31 reference statements)

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“…18 In a Melbourne hospital, even after promotion of gentamicin guidelines, only 30.3% of first doses were consistent with the guidelines. 19 In our study, patients who were not weighed experienced a significant increase (v 2 = 4.94, d.f. = 1, P = 0.03) in haemorrhagic complications with therapeutic anticoagulation.…”

Section: Number Of Subjectsmentioning

confidence: 94%

Failure to weigh patients in hospital: a medication safety risk

Hilmer

Rangiah

Bajorek

et al. 2007

Internal Medicine Journal

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Often patients are not weighed in hospital. Failure to weigh patients prescribed renally excreted drugs may correlate to adverse drug events. We carried out a cross-sectional study of patients prescribed common renally excreted drugs (heparin, enoxaparin and gentamicin), admitted to two wards at Royal North Shore Hospital, Sydney over 3 months. Of all patients surveyed, 28% (22/78) in the orthopaedic ward and 22% (27/124) in the medical ward were weighed. Among those prescribed therapeutic doses of the study drugs, 25% (3/12) in the orthopaedic ward and 27% (7/26) in the medical ward were weighed. Patients prescribed therapeutic anticoagulation who were not weighed experienced more haemorrhagic complications than patients who were weighed (P = 0.03). Patients prescribed renally excreted drugs in hospital are frequently not weighed. This is associated with reduced medication safety.

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Section: Number Of Subjectsmentioning

confidence: 94%

Failure to weigh patients in hospital: a medication safety risk

Hilmer

Rangiah

Bajorek

et al. 2007

Internal Medicine Journal

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“…European guidelines on the diagnosis and treatment of infective endocarditis were updated in October 2009 [4], and were in accordance with US guidelines regarding aminoglycoside use [5]. Studies in hospitals have shown that adherence to gentamicin prescribing guidelines is low [11,12]; in one study, 66% of the initial gentamicin dosings were not consistent with hospital guidelines [12]. In another hospital-based study, the use of a gentamicin monitoring form improved the proportion of appropriate starting doses from 65% to 90% [11].…”

Section: Introductionmentioning

confidence: 99%

A survey on the use of gentamicin in infective endocarditis

Béraud¹,

Moal²,

Elsendoorn³

et al. 2011

Eur J Clin Microbiol Infect Dis

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US and European guidelines recommend a daily divided gentamicin dose (3 mg/kg in two or three equally divided doses) for the treatment of infective endocarditis caused by staphylococci or enterococci, but once-daily dosing (3 mg/kg/day) is recommended for streptococcal endocarditis. However, studies have recommended the use of higher doses of gentamicin (4 or ≥5 mg/kg/day) administered once-daily. A survey was conducted in France by mailing a questionnaire to the 595 members of the French Infectious Disease Society regarding their gentamicin prescription patterns in infective endocarditis, focusing on the dosing regimen. The survey was answered by 137 physicians (23%). The proportions of physicians following guideline-based regimens were similar for each organism (30.9%, 38.8%, and 39.4% for staphylococci, enterococci, and streptococci, respectively [p=0.26]). In contrast, the proportions of physicians following literature-based regimens were significantly different for each organism (59.6%, 42.5%, and 27.7% for staphylococci, enterococci, and streptococci, respectively [p<0.001]). The number of years practicing and the type of practice (university vs. non-university hospital) did not influence the gentamicin dose or regimen. Although adherence to published guidelines for gentamicin administration in patients with infective endocarditis was poor, a large proportion of physicians who did not follow those guidelines used literature-based regimens.

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“…For example, only 58.7% of vancomycin use was in line with local guidance for dose, dose frequency and TDM measures in a Dutch intensive care unit,12 while 34% of initial gentamicin dosing was concordant with Australian hospital guidelines 9. No previous studies have examined barriers to the appropriate use of TDM for gentamicin and vancomycin although it has been suggested that merely providing guidelines and education is not sufficient to ensure compliance,9 and that further, multidisciplinary, research into the implementation of antimicrobial guidelines is needed 14…”

Section: Introductionmentioning

confidence: 99%

Barriers to the safe and effective use of intravenous gentamicin and vancomycin in Scottish hospitals, and strategies for quality improvement

et al. 2014

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Objectives Avoiding harm when patients interact with healthcare services is a global issue. Guidelines are often produced to improve the prescribing and monitoring of medication with a narrow therapeutic index. Adherence to guidelines may not occur in clinical practice. This paper aims to explore the barriers faced by clinical pharmacists and junior doctors when using complex guidelines to support the prescribing and therapeutic drug monitoring of gentamicin and vancomycin. Methods Twenty-three junior doctors and 27 clinical pharmacists took part in focus groups at four hospital sites in four Scottish health boards between March and July 2011. Focus groups were run separately at each hospital site for the two clinical groups. The data were organised using the framework approach, validated, and a thematic analysis was conducted. Results Five themes emerged to explain barriers to effective initial prescribing and therapeutic drug monitoring, which were divided into two types. Barriers could be a direct result of the content of the guidelines—specifically that clinicians required experience to use the guidelines effectively. Barriers also resulted from a failure in the context in which the guidelines function which was related to insufficient dissemination, communication issues within the hospital site, unmet educational needs and staffing issues. Conclusions Improved patient safety cannot be assumed due to the existence of gentamicin and vancomycin guidelines. The findings of this study highlight the complexities associated with their appropriate use. Future quality improvement strategies must consider where the guidelines will be implemented, and the context in which they will function

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Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Cited by 35 publications

References 18 publications

Failure to weigh patients in hospital: a medication safety risk

Failure to weigh patients in hospital: a medication safety risk

A survey on the use of gentamicin in infective endocarditis

Barriers to the safe and effective use of intravenous gentamicin and vancomycin in Scottish hospitals, and strategies for quality improvement

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