Effectiveness of a vancomycin restriction policy in changing the prescribing patterns of house staff

After noting a rise in vancomycin-resistant enterococci (VRE) infections, w e initiated a program to decrease inappropriate vancomycin use that focused on improvement of house staff prescribing practices. The initial intervent ion in June, 1995, encouraging house staff to follow hospital guidelines fo r vancomycin use and eliciting support from service chiefs in this effort, had little impact. A more intensive educational intervention, beginning in January, 1996, involved concurrent review of all vancomycin orders and one- on-one discussion with the house staff regarding the rationale for the orde r by an infectious diseases clinical pharmacist. When usage was deemed inap propriate, the pharmacist;asked that vancomycin be discontinued, but no aut omatic stop orders were issued. During the next two and one-half years, thi s second intervention proved effective at decreasing inappropriate use from 39% to 16.8% +/- 2.4% (p = 0.005). This change was primarily due to a decr ease in appropriate vancomycin prophylaxis by cardiothoracic surgery, VRE i nfections decreased from 0.29/100 patients discharged prior to initiating t he program to 0.13/100 patients discharged after the second intervention (p = 0.01). This educational program, although labor-intensive, preserved hou se staff decision-making skills related to antibiotic prescribing at the sa me time that it decreased inappropriate vancomycin use.