Impact of a Pharmacist-Initiated Vancomycin Monitoring Program

OBJECTIVES: Evaluate the clinical impact of pharmacist-initiated vancomycin monitoring and dosing in a long-term care setting.

DESIGN: Single-center, pretest, post-test design.

SETTING: Rutland Nursing Home, Brooklyn, New York.

PARTICIPANTS: Nursing facility residents treated with intravenous vancomycin (N = 198).

OUTCOME MEASURES: The primary objective is to determine the incidence of acute kidney injury (AKI) a year before and a year after implementation of a pharmacist-initiated vancomycin-monitoring protocol. The secondary objectives are percentage of serum drug levels in therapeutic range and compliance with laboratory testing for monitoring of nephrotoxicity.

RESULTS: The overall incidence of AKI decreased from 16.3% (8/49) to 4.7% (7/149) (P = 0.013). Compliance with weekly monitoring for nephrotoxicity via serum creatinine and blood urea nitrogen improved from 76% (37/49) to 95% (141/149) (P ≤ 0.001). Compliance with weekly vancomycin level monitoring improved from 71% (35/49) to 85% (126/149) (P = 0.041). Percentage of vancomycin trough levels in the therapeutic range of 10-20 mcg/mL were shown to have no difference between two groups, but vancomycin levels > 20 mcg/mL decreased from 31% (15/49) to 17% (26/149) (P = 0.048).

CONCLUSION: Implementation of pharmacist-driven vancomycin monitoring significantly improved monitoring compliance of vancomycin serum levels and kidney function as well as reduced the incidence of AKI in the long-term care setting.