A quality control analysis of aminoglycoside management

Aminoglycoside administration practices were evaluated in a teaching hospital using three study methods: a chart review of 40 randomly selected patients receiving aminoglycosides was conducted retrospectively; 93 health care personnel involved in ordering and administering aminoglycosides to patients were interviewed regarding their understanding of aminoglycoside utilization practices; and ten patients having serum peak and trough aminoglycoside determinations were closely monitored for accuracy of dose administration and obtaining blood specimens at appropriate times. The chart review showed that during 15 of 32 evaluable therapy courses no determinations of serum aminoglycoside concentration were obtained. The survey demonstrated that only 24% of the residents actually used the results of peak and trough determinations to adjust dosage regimens. Direct observation of health care personnel disclosed only two of ten instances in which doses were administered and serum concentration specimens obtained with no apparent problems. Most personnel in our hospital were unaware of these pervasive suboptimal or inconsistent practices associated with aminoglycoside administration and interpretation of laboratory results.