Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-15T06:42:02.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of Pharmacy Policies Designed to Limit Inappropriate Vancomycin Use: A Population-Based Assessment

Published online by Cambridge University Press:  02 January 2015

Ann R. Thomas ,
Paul R. Cieslak ,
Larry J. Strausbaugh  and
David W. Fleming
Ann R. Thomas*
Affiliation:
Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Paul R. Cieslak
Affiliation:
Department of Human Services, Office of Disease Prevention and Epidemiology, Portland, Oregon
Larry J. Strausbaugh
Affiliation:
Veterans Affairs Medical Center and the Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, Oregon
David W. Fleming
Affiliation:
Department of Human Services, Office of Disease Prevention and Epidemiology, Portland, Oregon
*
Department of Human Services, Office of Disease Prevention and Epidemiology, 800 NE Oregon Street, Suite 772, Portland, OR 97232
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

In Oregon in 1994, a population-based study of 66 nonpsychiatric hospitals indicated that 40% of vancomycin orders were inappropriate according to Centers for Disease Control and Prevention guidelines. We repeated the study to determine whether vancomycin use had been affected by pharmacy policies implemented following the 1994 study.

Methods:

We surveyed pharmacists in nonpsychiatric hospitals in Oregon regarding vancomycin use policies in their hospitals. Using pharmacy records, we identified and abstracted the charts of all patients in Oregon hospitals receiving vancomycin during a 3-week period to determine appropriate use of vancomycin.

Results:

Thirteen (20%) of 64 hospitals had implemented a vancomycin restriction policy since 1994; none of the remaining hospitals in the study had a policy. In 1999, hospitals with vancomycin restriction policies had substantially decreased rates of inappropriate vancomycin use compared with hospitals without such policies (1.0 vs 1.8 orders per 1,000 patient-days; P = .01). Compared with 1994 baseline rates of inappropriate use, hospitals that adopted policies experienced a decrease (from 1.5 orders per 1,000 patient-days in 1994 to 1.0 in 1999; P= .13), whereas hospitals without policies experienced a statistically significant increase (from 0.9 orders per 1,000 patient-days in 1994 to 1.8 in 1999; P = .001). Restriction policies were most effective at reducing rates of inappropriate use for treatment of confirmed gram-positive infections and prophylaxis.

Conclusion:

Vancomycin restriction policies were associated with a decrease in inappropriate therapeutic and prophylactic vancomycin use, but had no effect on inappropriate empiric use. Hospitals considering limits regarding inappropriate use should consider implementation of institution-based vancomycin restriction policies as part of an overall strategy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 683 - 688
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(RR12):1–13.Google Scholar
2.Hiramatsu, K, Hanaki, H, Ino, T, Yabuta, K, Oguri, T, Tenover, F. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40:135–136.Google Scholar
3.Rotun, SS, McMath, V, Schoonmaker, D, et al. Staphylococcus aureus with reduced susceptibility to vancomycin isolated from a patient with fatal bacteremia. Emerg Infect Dis 1999;5:147–149.Google Scholar
4.Smith, TL, Pearson, ML, Wilcox, KR, et al. Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999;340:493–501.Google Scholar
5.Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin: Illinois, 1999. MMWR 2000;48: 1165–1167.Google Scholar
6.Garrett, DO, Jochimsen, E, Murfitt, K, et al. The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis. Infect Control Hosp Epidemiol 1999;20:167–170.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1990-May 1999. Am J Infect Control 1999;27:520–532.Google Scholar
8.Salemi, C, Becker, L, Morrissey, R, Warmington, J. A clinical decision process model for evaluating vancomycin use with modified HICPAC guidelines. Clinical Performance and Quality Health Care 1998;6:12–16.Google Scholar
9.Wright, SW, Wrenn, KD. Appropriateness of vancomycin use in the emergency department. Ann Emerg Med 1998;32:531–536.CrossRefGoogle ScholarPubMed
10.Evans, ME, Kortas, KJ. Vancomycin use in a university medical center: comparison with Hospital Infection Control Practices Advisory Committee guidelines. Infect Control Hosp Epidemiol 1996;17:356–359.Google Scholar
11.Johnson, SV, Hoey, LL, Vance-Bryan, K. Inappropriate vancomycin prescribing based on criteria from the Centers for Disease Control and Prevention. Pharmacotherapy 1995;15:579–585.CrossRefGoogle ScholarPubMed
12.Beidas, S, Khamesian, M. Vancomycin use in a university medical center: comparison with Hospital Infection Control Practices Advisory Committee guidelines. Infect Control Hosp Epidemiol 1996;17:773–774.CrossRefGoogle Scholar
13.Kahyaoglu, O, Akpinar, M, Nolan, B, Inoue, S, Zureikat, G, Kumar, A. Vancomycin use and monitoring in pediatric patients in a community hospital. Infect Control Hosp Epidemiol 1998;19:299, 301. Letter.CrossRefGoogle Scholar
14.Logsdon, BA, Lee, KR, Luedtke, G, Barrett, FF. Evaluation of vancomycin use in a pediatric teaching hospital based on CDC criteria. Infect Control Hosp Epidemiol 1997;18:780–782.Google Scholar
15.Morgan, AS, Brennan, PJ, Fishman, NO. Impact of a vancomycin restriction policy on use and cost of vancomycin and incidence of vancomycin-resistant Enterococcus. Ann Pharmacother 1997;31:970–973.CrossRefGoogle ScholarPubMed
16.Goeckner, BJ, Hendershot, E, Scott, K, Drake, M. A vancomycin monitoring program at a community hospital. Jt Comm J Qual Improv 1998;24: 379–385.Google Scholar
17.Anglim, AM, Hym, B, Byers, KE, Scheld, WM, Farr, BM. Effect of a vancomycin restriction policy on ordering practices during an outbreak of vancomycin-resistant Enterococcus faecium. Arch Intern Med 1997;157: 1132–1136.CrossRefGoogle ScholarPubMed
18.Watanakunakorn, C. Prescribing pattern of vancomycin in a community teaching hospital with low prevalence of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997;18:767–769.CrossRefGoogle Scholar
19.Lipsky, BA, Baker, CA, McDonald, LL, Suzuki, NT. Improving the appropriateness of vancomycin use by sequential interventions. Am J Infect Control 1999;27:84–91.Google Scholar
20.Cieslak, PR, Strausbaugh, LJ, Fleming, DW, Ling, JM. Vancomycin in Oregon: who's using it and why. Infect Control Hosp Epidemiol 1999; 20:557–560.Google Scholar
21.Quale, J, Landman, D, Saurina, G, Atwood, E, DiTore, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.Google Scholar
22.Belliveau, PP, Rothman, AL, Maday, CE. Limiting vancomycin use to combat vancomycin-resistant Enterococcus faecium. Am J Health Syst Pharm 1996;53:1570–1575.Google Scholar
23.Shojania, KG, Yokoe, D, Platt, R, Fiskio, J, Ma'luf, N, Bates, DW. Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J Am Med Inform Assoc 1998;5:554–562.Google Scholar
24.Misan, GM, Martin, ED, Smith, ER, Somogyi, AA, Bartholomeusz, RC, Bochner, F. Drug utilization review in a teaching hospital: experience with vancomycin. Eur J Clin Pharmacol 1990;39:457–461.Google Scholar
25.Singer, MV, Haft, R, Barlam, T, Aronson, M, Shafer, A, Sands, KE. Vancomycin control measures at a tertiary-care hospital: impact of interventions on volume and patterns of use. Infect Control Hosp Epidemiol 1998;19:248–253.Google Scholar
26.Briceland, LL, Quintiliani, R, Nightingale, CH. Multidisciplinary cost-containment program promoting oral metronidazole for treatment of antibiotic-associated colitis. Am J Hosp Pharm 1988;45:122–125.Google ScholarPubMed