Vancomycin AUC-Dosing Initiative at a Regional Antibiotic Stewardship Collaborative

Area of Science:

• Health Services Research
• Infectious Diseases
• Pharmacology

Background:

• Antibiotic stewardship programs (ASPs) are mandated by the Veterans Health Administration (VHA) across all facilities.
• Regional Veterans Integrated Service Networks (VISNs) are required to develop ASP collaboratives.
• VISN 8 serves over 1.5 million veterans, establishing a model ASP workgroup in 2015.

Purpose of the Study:

• To evaluate the effectiveness of a regional ASP collaborative model.
• To assess the impact of multisite quality initiatives within the VHA.
• To demonstrate the VHA's leadership in antimicrobial stewardship.

Main Methods:

• The VISN 8 ASP workgroup, comprising ASP champions from each medical center, meets monthly.
• The collaborative facilitated a multisite quality initiative implementing area under the curve (AUC)-guided vancomycin dosing.
• Quality assurance evaluations were conducted to identify best practices.

Main Results:

• AUC-guided vancomycin dosing was implemented across 4 healthcare systems within VISN 8.
• This approach led to significantly decreased rates of acute kidney injury (2.4%) compared to trough-based dosing (10.4%).
• The quality assurance evaluation identified best practices for dissemination across the VISN.

Conclusions:

• The VISN 8 ASP workgroup demonstrates effective collaboration for optimizing antimicrobial use and impacting large veteran populations.
• ASP collaboratives leverage collective size for robust multisite quality assurance evaluations.
• The expansion of this model highlights the VHA as a leader in national ASP best practices.