Implementation of an Automatic 48-Hour Vancomycin Hard-Stop in a Pediatric Community Hospital.

Autor:	Cowart MC; Department of Pharmacy (MCC), Arnold Palmer Hospital for Children, Orlando, FL., Miller D; Department of Pharmacy (DK), Cook Children's Health Care System, Fort Worth, TX., Laham FR; Department of Pediatrics (FRL, AJ-V), Arnold Palmer Hospital for Children, Orlando, FL., Jordan-Villegas A; Department of Pediatrics (FRL, AJ-V), Arnold Palmer Hospital for Children, Orlando, FL.
Jazyk:	angličtina
Zdroj:	The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG [J Pediatr Pharmacol Ther] 2022; Vol. 27 (2), pp. 147-150. Date of Electronic Publication: 2022 Feb 09.
DOI:	10.5863/1551-6776-27.2.147
Abstrakt:	Objective: Previous studies evaluating antimicrobial time-outs and required stop dates on antimicrobial orders indicate that these strategies are effective in decreasing antimicrobial duration and cost without a negative impact on patient outcomes. Few have evaluated use of a hard-stop strategy. The purpose of this study was to determine the feasibility and impact of a vancomycin hard-stop at 48 hours of therapy on vancomycin use. Methods: This retrospective review compared 2 groups, a hard-stop pre-implementation group from April 2018 through March 2019 and a hard-stop post-implementation group from May 2019 through April 2020. The primary outcome was change in days of therapy (DOT) per ordered course of vancomycin therapy. Secondary outcomes included DOT per 1000 patient days (PD), number of courses continued beyond 48 hours, number of vancomycin concentrations drawn and drug acquisition cost. Results: A total of 554 courses of vancomycin were prescribed (228 in the pre-implementation group and 326 in the post-implementation group). The median DOT per ordered course of vancomycin was 1.58 days (IQR, 1.00-2.59) in the pre-implementation group compared with 1.55 days (IQR, 1.00-1.99) in the post-implementation group (p = 0.51). Fewer vancomycin courses continued beyond 48 hours after hard-stop implementation (23% versus 33%) and fewer vancomycin concentrations were obtained in the post-implementation period than in the pre-implementation period despite more ordered courses of vancomycin therapy, 114 concentrations versus 153 concentrations, respectively. Overall, the total yearly drug acquisition cost savings to the pharmacy equated to $3000. Conclusions: Implementation of a vancomycin hard-stop at 48 hours of therapy is a feasible antimicrobial stewardship tool that may have significant clinical and operational impacts. Competing Interests: Disclosures. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2022.)
Databáze:	MEDLINE
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