Development and evaluation of a national gentamicin and vancomycin quality improvement programme

Area of Science:

• Pharmacology
• Quality Improvement Science
• Public Health

Background:

• Scottish Antimicrobial Prescribing Group (SAPG) recommendations to reduce broad-spectrum antimicrobial use inadvertently increased gentamicin and vancomycin prescribing.
• National guidance was introduced in 2009 to standardize dosing, reduce errors, and improve monitoring of these antibiotics.
• Studies in 2010-2011 revealed challenges in implementing the existing guidelines.

Purpose of the Study:

• To develop, implement, and evaluate the long-term impact of quality improvement (QI) resources for gentamicin and vancomycin.
• To enhance prescribing, administration, and monitoring practices for these key antibiotics.

Main Methods:

• Development and implementation of revised guidelines, dose calculators (online and mobile app), educational materials, and specialized charts across Scotland (2013-2016).
• An online survey in 2017 assessed resource utilization.
• A point prevalence study compared prescribing practices in 2011 (before) and 2018 (after).

Main Results:

• High adoption rates: 80% of health boards used the guidance, electronic calculators, and gentamicin charts; 8 used vancomycin charts.
• Significant increase in correct gentamicin dosing: from 44% in 2011 to 89% in 2018 (OR 10.99).
• Improved vancomycin dosing: correct loading dose rose from 50% to 85% (OR 5.69), and correct maintenance dose from 55% to 90% (OR 7.17).

Conclusions:

• Coordinated development and implementation of QI resources, alongside multidisciplinary team engagement, led to national improvements in gentamicin and vancomycin prescribing.
• The study demonstrates the effectiveness of a comprehensive QI strategy in optimizing antibiotic use.
• Sustained improvements in antibiotic dosing accuracy and monitoring were achieved through standardized resources.