Antimicrobial Stewardship Initiatives Optimize Vancomycin Dosing and Reduce Nephrotoxicity

Antimicrobial Stewardship Programs direct judicious antimicrobial use to optimize patient outcomes and improve patient safety. New pharmacokinetic services were implemented as part of the medical center's ASP's patient safety initiatives to optimize antimicrobial dosing and also inline with the institution's pharmacy practice model expansion. Vancomycin target trough attainment, dosing and clinical outcomes were compared pre- and post-implementation of new PK services in adult inpatients who received therapeutic intravenous vancomycin. Post-implementation of new PK services, there were greater proportion of vancomycin courses with therapeutic initial trough concentrations (27.5% versus 46.1%, p = 0.002), higher initial trough concentrations (10.9 mcg/mL versus 16.4 mcg/mL, p < 0.001), greater proportion of therapeutic courses (59.5% versus 77.3%, p < 0.001), and significant reduction in the incidence of vancomycin-associated nephrotoxicity (21.1% versus 11.7%, p = 0.038). Their study demonstrated the impact of an ASP safety initiative of advancing PK services in optimizing vancomycin target trough attainment and improving patient safety.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)