Vancomycin use in a university medical center: Effect of a vancomycin continuation form

OBJECTIVE: To examine the impact of a new policy to ensure appropriate use of vancomycin in a 461-bed tertiary-care hospital. DESIGN: We instituted a policy that allowed physicians to prescribe vancomy cin but that required them to complete a vancomycin continuation form and d ocument that use conformed to Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines if they wished to continue the drug beyond 7 2 hours. Vancomycin was stopped automatically at 72 hours if use was not co nsistent with guidelines, if an infectious diseases consultant did not appr ove the drug, or if the form was not completed. A pharmacist and infectious diseases specialist monitored use of vancomycin prospectively and interact ed with prescribers when indicated. Educational efforts were limited to pri nting the HICPAC guidelines on the form and providing information about the policy in a newsletter Patterns of prescribing and the economic impact of the form were evaluated over a 6-month period. RESULTS: Only 29% to 48% of vancomycin orders initially met HICPAC guidelin es, but 77% to 96% of use was appropriate after 72 hours when the form was used. Inappropriate surgical prophylaxis, empirical therapy of intensive-ca re unit and transplant patients, and therapy for inadequately documented co agulase-negative staphylococcal infections remained problems. Vancomycin us e fell from a mean of 136 (+/- 52) g/1,000 patient days in the 12 months be fore the form to 78 (+/- 22) g/1,000 patient days in the 9 months after ins titution of the form (P<.05). Net vancomycin acquisition costs and costs of ordering vancomycin serum levels fell by $357 and $19 per 1,000 patient da ys, respectively (P<.05). This represented annualized saving of approximate ly $47,000 in drug and monitoring costs. No adverse patient outcomes were s een as a result of the program. CONCLUSIONS: A vancomycin continuation form can decrease inappropriate vanc omycin use and may save money. Additional educational efforts may be requir ed to increase compliance with HICPAC guidelines during initial prescribing (Infect Control Hosp Epidemiol 1999;20:417-420).