Transitioning From Consult-Based to Automatic Pharmacy-Driven Vancomycin Management: Results From a Single, Primary...

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Quality Improvement

Background:

• Transitioning to area under the curve (AUC) vancomycin monitoring necessitates significant pharmacy policy and procedure updates.
• The study facility shifted from a consult-based collaborative agreement to automatic pharmacist management for all intravenous (IV) vancomycin orders.

Purpose of the Study:

• To evaluate the effectiveness of transitioning to AUC vancomycin monitoring under an automatic pharmacist management policy.
• To assess the impact of this transition on clinical outcomes and pharmacist documentation.

Main Methods:

• A quality assessment (QA) study was conducted evaluating pharmacist assessments and documentation for IV vancomycin from January-June 2020.
• Primary outcome: proportion of patients with documented pharmacokinetic and dosing assessments.
• Secondary outcomes: proportion of AUC24 levels within therapeutic range, incidence of acute kidney injury (AKI), and treatment failures compared to a historical trough-based cohort.

Main Results:

• 100% of patients (n=88) in the QA analysis had pharmacist assessment with documentation.
• 45% of monitored patients achieved AUC24 levels within the desired range.
• Rates of AKI (9% vs 11%) and treatment failures (3% vs 0%) were similar between the AUC and historical trough-based groups.

Conclusions:

• The transition to automatic pharmacist management for AUC vancomycin monitoring was successful.
• This new model demonstrated comparable safety and efficacy to the previous trough-based approach.
• The study highlights the feasibility of implementing AUC vancomycin monitoring through automated pharmacy management.