Emergency medicine clinical pharmacist's impact on ordering of vancomycin loading doses

To determine the impact of an emergency medicine clinical pharmacist's (EMCP) intervention on physicians' prescribing of vancomycin loading doses at an institution with limited EMCP services.

This was a retrospective, pre-post intervention study conducted at an academic Level 1 trauma center. Adult patients who were ordered vancomycin and a broad spectrum antimicrobial at the same time, within 12 h of arrival to the emergency department were included. During the three week intervention phase the EMCP lectured physicians and pharmacists on appropriate vancomycin loading doses, posted flyers in the ED physicians' work rooms, and uploaded a handout to the department of pharmacy's website. Primary analysis compared the number of appropriate vancomycin loading doses ordered before and after the EMCP intervention.

Thirty and 31 orders from the pre- and post-intervention study periods were included in data analysis, respectively. The number of appropriate vancomycin orders prescribed significantly increased from 2 (6.7%) to 11 (35%) following the intervention (p < 0.05).

Following an EMCP intervention there was a statistically significant increase in the number of appropriate vancomycin loading dose orders prescribed by emergency medicine physicians. The EMCP's unique skill set and role within the emergency department permitted the EMCP to recognize and resolve a discrepancy in vancomycin prescribing practices. This study further highlights the importance of having dedicated clinical pharmacists in the emergency department and encourages institutions to develop, expand, and maintain EMCP positions.