Implementation of the systems approach to improve a pharmacist-managed vancomycin dosing service

Area of Science:

• Pharmacoeconomics
• Health Services Research
• Clinical Pharmacy

Background:

• The vancomycin dosing service faced increased patient volumes and resource demands.
• A comprehensive evaluation was needed to optimize the service.

Purpose of the Study:

• To describe quality improvements from applying a systems approach to a pharmacist-managed vancomycin dosing service.
• To assess clinical effectiveness, operational efficiency, and financial feasibility.

Main Methods:

• A multidisciplinary committee (pharmacy, medicine, infectious diseases, nursing, phlebotomy, clinical laboratory) was formed.
• Consensus-building methods were used over three moderated sessions.
• The systems approach involved assessing system inputs, processes, and outcomes.

Main Results:

• The systems approach identified more improvements than a pharmacy-only assessment.
• Implemented changes include pharmacists ordering vancomycin levels without physician cosignature.
• A vancomycin dosing algorithm was added to the antibiotic dosing guide.

Conclusions:

• The systems approach facilitated a thorough, multidisciplinary evaluation of the vancomycin dosing service.
• This approach identified process improvements missed by the pharmacy department alone.
• Future changes aim to optimize resource allocation for vancomycin dosing services.