Measuring and improving the timeliness of vancomycin therapeutic drug monitoring and potential patient safety impacts

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy Pub Date : 2023-12-17 DOI:10.1016/j.rcsop.2023.100403

Belinda Chappell , Benita Suckling , Champika Pattullo

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Abstract

Background

Timely vancomycin therapeutic drug monitoring (TDM) enables prompt dose adjustments and safe treatment. Local incidents prompted an investigation into the reasons for prolonged reporting times.

Objectives

To investigate the variation in reporting times of vancomycin concentrations between hospitals with and without on-site TDM processing, and patient safety implications.

Methods

Vancomycin concentration results for Hospital 1 (off-site monitoring), Hospitals 2 and 3 (both on-site monitoring) from June to December 2021 were retrospectively analysed. Retrospective data collection was repeated for Hospital 1 three months post on-site TDM commencement for comparison. Vancomycin clinical incidents at Hospital 1 were reviewed to identify examples of when delays in reporting of results potentially contributed towards adverse patient outcomes.

Results

Hospital 1 had a median reporting time of 11.13 h compared with Hospital 2 and Hospital T3 (1.73 h and 1.70 h respectively). Following the commencement of on-site TDM at Hospital 1, the reporting time reduced to 1.33 h (p < 0.001). Several incidents at Hospital 1 during the period of off-site monitoring involved delays to TDM results.

Conclusions

Off-site processing of TDM introduced significant delays in reporting of vancomycin concentrations, which was significantly improved by transitioning to onsite availability of testing. This study also highlights the impact of accurate problem identification in improving patient safety.

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衡量和改进万古霉素治疗药物监测的及时性及其对患者安全的潜在影响

背景及时的万古霉素治疗药物监测（TDM）有助于及时调整剂量和安全治疗。方法对 2021 年 6 月至 12 月期间第一医院（非现场监测）、第二医院和第三医院（均为现场监测）的万古霉素浓度结果进行回顾性分析。在现场 TDM 开始三个月后，对第一医院重复进行了回顾性数据收集，以进行比较。对第一医院发生的万古霉素临床事件进行回顾，以确定延迟报告结果可能导致患者不良结局的实例。结果第一医院的中位报告时间为 11.13 h，而第二医院和第三医院分别为 1.73 h 和 1.70 h。在第一医院开始现场 TDM 后，报告时间缩短至 1.33 小时（p < 0.001）。在非现场监测期间，第一医院发生的几起事故都涉及到 TDM 结果的延迟。结论非现场处理 TDM 会导致万古霉素浓度报告的严重延迟，而过渡到现场检测后，延迟情况得到了明显改善。这项研究还强调了准确识别问题对提高患者安全的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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