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Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients.

ABSTRACT: Many institutions have guidelines for initiation and monitoring, but not timing, of vancomycin.Our objective was to evaluate vancomycin trough collection appropriateness before and after an initiative to change the dosing and trough collection times in ward patients.A retrospective cohort study of ward patients from May 2014-16 who received scheduled intravenous vancomycin was performed. Nurse managers and pharmacists provided staff education. Differences between pre- and post-intervention groups were compared using student's t-test for continuous data and chi-square test for categorical data.Baseline characteristics were similar between the pre-intervention (n=124) and post-intervention (n=122) groups except for weight-based maintenance dose (15.3 mg/kg vs. 16.5 mg/kg, p=0.03) and percentage of troughs collected with morning labs (14% vs. 87%, p<0.001). Patients in the pre- and post-intervention groups received a similar frequency of loading doses (14.5% vs. 16%, p=0.68). There was no significant difference in percentage of vancomycin troughs collected appropriately at 30 (40% vs. 42%, p=0.72), 60 (57% vs. 63%, p=0.35), or 75 (60% vs. 68%, p=0.22) minutes from the scheduled time of the next dose.Staff education and standardizing collection of vancomycin troughs with morning blood collections did not affect the percentage of appropriately collected vancomycin troughs.

SUBMITTER: Hammond DA

PROVIDER: S-EPMC5499355 | biostudies-other | 2017 Apr-Jun

REPOSITORIES: biostudies-other

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Project description:Workers' compensation (WC) insurers collect large amounts of industrial hygiene (IH) data in the United States. The data collected is not easily accessible for research or surveillance purposes. Individual WC insurers are using computerized systems to standardize and store the IH data, leaving a gap in standardization among the different WC insurers. This study sought to standardize IH data collection among WC insurers and to determine the feasibility of pooling collected IH data. IH air and noise survey forms were collected from WC insurers. Data fields on the forms were evaluated for importance and a study list of core fields was developed. The core study list was presented to an IH review panel for review before finalization. The final core study list was compared to recommendations published by the American Conference of Governmental Industrial Hygienists (ACGIH) and the American Industrial Hygiene Association (AIHA). Fifty-nine forms from 10 organizations were collected. Industrial hygienists from research organizations, state-based WC insurers, and private WC insurers participated in the data field evaluation and on the review panel. For both air and noise survey forms, more than half the data fields (55% and 54%, respectively) were ranked as "essential." Three of the four fields in the worker and control observations category ranked "essential" were found less than half of the time on both types of survey forms. The study list of core data elements consisted of more than half of the data fields from both the air and noise survey forms. Three additional fields were added based on the comparison to the ACGIH-AIHA recommendations. Data fields essential to standardizing IH data collection were identified and verified. The "essential" data fields will be made available and have the potential to be incorporated into WC insurers electronic IH data management systems. Future research should focus on other IH survey forms, such as those used in ergonomic assessments and specific chemical exposures, and methods to transfer data fields to electronic platforms.

Dataset Information

Effects of staff education and standardizing dosing and collection times on vancomycin trough appropriateness in ward patients.

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