NSG6999 W6 D2 – Administering Vancomycin

NSG6999 W6 D2 – Administering Vancomycin

NSG6999 W6 D2 – Administering Vancomycin : PICOT In nurses administering vancomycin, does implementing a specific clinical decision support tool that is design to fire a pop up alert to the nurse at the point of medication administration, to alert the nurse only when there is no vancomycin trough resulted, or if there is an elevated trough level that is detected compared to the usual vancomycin administration workflow which, reduce the incidence of vancomycin given erroneously without inducing alert fatigue?

Vancomycin is a drug that must be monitored closely through serum trough concentrations as the risk for resistance and nephrotoxicity can occur with levels great than 20mg/L.  The target goal for treatment is levels greater than 10mg/L to avoid resistance, and a target of 15-20mg/L as a guideline for a therapeutic range.  The study revealed that out of 21,185 patients intravenous vancomycin was given, and 7,422 had trough levels checked, and 755 had elevated levels (Zonozi , Wu, Shin, Secora, & Coresh, 2019) . The importance of effective monitoring of trough levels can lead to early detection of vanomycin levels that are supra or sub therapeutic, or if guidelines are not being followed in correct ordering of troughs which can to negative outcomes for patients receiving vancomycin. One study revealed, the implementation of a clinical decision support tool algorithm that displays a pop-up alert to physicians when vancomycin or gentamycin was ordered, but no plasma concentration was detected or no plasma order had been placed increased the compliance of monitoring.  The alert was set to only fire if a patient has received vanomycin or gentamycin in the previous 48 hours and met the above criteria of no concentration available, and give the physician an option to order the lab. Prior to the study, 56% patient had concentrations measured too late, and only 47% of treatments received a measurement within the 72 hours.  After the implementation the percentage increased to 80% and the time of administration of proper dosage was dramatically decreased (Pereboom, Mulder , Verweij, van der Hoeven , & Becker, 2018).

References

Pereboom, M., Mulder , I. J., Verweij, S. L., van der Hoeven , R. T., & Becker , M. L. (2018, November ). A clinical decision support system to improve adequate dosing of gentamycin and vancomycin . international journal of medical informatics , 1-5. http://dx.doi.org/https://doi.org/10.1016/j.ijmedinf.2019.01.002

Zonozi , R., Wu, A., Shin, J., Secora, A., & Coresh, J. (2019, January ). Elevated vancomycin trough levels in tertiary health system: frequency, risk factors, and prognosis . May Clinic Proceedings , 94(1). http://dx.doi.org/doi:http://dx.doi.org/10.1016/j.mayocp.2018.08.034

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