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Minne L. 1, Eslami S. 1, Kuiper R. A. 2, Abu-Hanna A. 1, Dongelmans D. A. 3
1 Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands;
2 Zuwe Hofpoort Hospital, Hospital Pharmacy, Woerden, The Netherlands;
3 Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
BACKGROUND: This study aims to assess clinicians’ behaviour in prescribing vancomycin in the Intensive Care Unit (ICU) and their adherence to local guidelines for therapeutic drug monitoring (TDM).
METHODS: In this observational cohort study we included all consecutive patients admitted to a 28-bed multidisciplinary mixed adult ICU of a large university hospital in Amsterdam between January 2002 and September 2007 who were prescribed vancomycin for ≥3 days. We measured guideline adherence by checking for each given advice the corresponding action and monitored adherence over time using Statistical Process Control.
RESULTS: In 475 patients prescribed vancomycin, 1336 serum concentrations were measured, of which 598 in time and 738 with a median delay of 31 hours. Dose or dose frequency adjustments were often not done (54% in advice 2 [half dose frequency] and 86% in advice 4 [increase dose with 50%]) or not done concordantly (32% in advice 2 [half dose frequency] and 60% in advice 7 [half dose frequency if trough serum concentration]). Although adherence was stable over time, the average level was low (58.7%).
CONCLUSION: Five years of TDM did not achieve the desired prescription behaviour in the ICU and clinicians feel there is a need for computerized decision support. Local projects should measure adherence and implement appropriate solutions.