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Published on: April 18, 2019
Implementation of an Automatic 48-Hour Vancomycin Hard-Stop in a Pediatric Community Hospital
Mallory C Cowart1, Danielle Miller2, Federico R Laham3
1Department of Pharmacy (MCC), Arnold Palmer Hospital for Children, Orlando, FL.
Objective:
Previous studies evaluating antimicrobial time-outs and required stop dates on antimicrobial orders indicate that these strategies are effective in decreasing antimicrobial duration and cost without a negative impact on patient outcomes. Few have evaluated use of a hard-stop strategy. The purpose of this study was to determine the feasibility and impact of a vancomycin hard-stop at 48 hours of therapy on vancomycin use.
Methods:
This retrospective review compared 2 groups, a hard-stop pre-implementation group from April 2018 through March 2019 and a hard-stop post-implementation group from May 2019 through April 2020. The primary outcome was change in days of therapy (DOT) per ordered course of vancomycin therapy. Secondary outcomes included DOT per 1000 patient days (PD), number of courses continued beyond 48 hours, number of vancomycin concentrations drawn and drug acquisition cost.
Results:
A total of 554 courses of vancomycin were prescribed (228 in the pre-implementation group and 326 in the post-implementation group). The median DOT per ordered course of vancomycin was 1.58 days (IQR, 1.00-2.59) in the pre-implementation group compared with 1.55 days (IQR, 1.00-1.99) in the post-implementation group (p = 0.51). Fewer vancomycin courses continued beyond 48 hours after hard-stop implementation (23% versus 33%) and fewer vancomycin concentrations were obtained in the post-implementation period than in the pre-implementation period despite more ordered courses of vancomycin therapy, 114 concentrations versus 153 concentrations, respectively. Overall, the total yearly drug acquisition cost savings to the pharmacy equated to $3000.
Conclusions:
Implementation of a vancomycin hard-stop at 48 hours of therapy is a feasible antimicrobial stewardship tool that may have significant clinical and operational impacts.
Insights
Implementing a vancomycin hard-stop at 48 hours is feasible and effective for antimicrobial stewardship. This strategy reduced vancomycin duration and costs without negatively impacting patient outcomes.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacy
Background:
- Antimicrobial stewardship programs aim to optimize antibiotic use.
- Strategies like time-outs and stop dates reduce antibiotic duration and cost.
- The impact of hard-stop strategies, specifically for vancomycin, requires further evaluation.
Purpose of the Study:
- To assess the feasibility of implementing a vancomycin hard-stop at 48 hours.
- To determine the impact of this hard-stop strategy on vancomycin utilization.
- To evaluate clinical and operational outcomes associated with the vancomycin hard-stop.
Main Methods:
- Retrospective review comparing pre- and post-implementation groups (April 2018-March 2019 vs. May 2019-April 2020).
- Primary outcome: change in vancomycin days of therapy (DOT) per ordered course.
- Secondary outcomes: DOT per 1000 patient days, courses exceeding 48 hours, vancomycin concentrations, and drug acquisition cost.
Main Results:
- Median DOT per course was similar pre- and post-implementation (1.58 vs. 1.55 days; p=0.51).
- Fewer vancomycin courses continued beyond 48 hours post-implementation (23% vs. 33%).
- Reduced vancomycin concentrations drawn and $3000 in annual drug acquisition cost savings were observed post-implementation.
Conclusions:
- A 48-hour vancomycin hard-stop is a feasible antimicrobial stewardship tool.
- This strategy demonstrates potential for significant clinical and operational benefits.
- Hard-stop implementation can effectively reduce unnecessary vancomycin exposure and associated costs.
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