Impact of a Series of Interventions in Vancomycin Prescribing on Use and Prevalence of Vancomycin-Resistant Enterococci

Authors: Guglielmo, B. Joseph; Dudas, Vicky; Maewal, Ila; Young, Rebecca; Hilts, Alexandra; Villmann, Mark; Gibbs, Laurel; Gropper, Michael; Jacobs, Richard

Source: Joint Commission Journal on Quality and Patient Safety, Volume 31, Number 8, August 2005 , pp. 469-475(7)

Publisher: Joint Commission Resources

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Abstract:

Background: In response to vancomycin-resistant bacteria, particularly vancomycin-resistant enterococci (VRE), measures have been recommended to improve on the appropriate use of vancomycin.

Methods: Intervention 1 consisted of an automatic 72-hour vancomycin stop order; Intervention 2, a standardized procedure for sampling of blood cultures; and Intervention 3, an interdisciplinary critical care team.

Results: After Intervention 1, inappropriate use decreased, particularly in treatment of febrile neutropenia and undocumented gram-positive infections. After Intervention 2, the baseline rate of inappropriately drawn blood cultures (IDBCs) was unchanged, and use in patients with IDBCs was comparable during both periods. Before Intervention 3, 38/55 orders continuing > 72 hours were considered inappropriate versus 24/53 (p < .025) after. After the interventions, hospital-wide vancomycin use was reduced. Yet the overall rate of VRE infection initially decreased but then increased once again over time.

Discussion: Despite substantial reduction in hospital-wide vancomycin use, the impact on the overall rate of VRE was inconsistent and ward dependent.

Document Type: Research article

Publication date: 2005-08-01

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Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

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Impact of a Series of Interventions in Vancomycin Prescribing on Use and Prevalence of Vancomycin-Resistant Enterococci

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