Background: Pharmacokinetic vancomycin dosing protocols are widely developed and utilized in inpatient healthcare settings. Not only is there insufficient data regarding pharmacy-managed vancomycin protocols in the home infusion setting, but this institution identified inconsistencies in their internal management of patients requiring vancomycin therapy secondary to lacking an institutional protocol.
Purpose: The purpose of this quality improvement study is to identify opportunities for pharmacists to improve efficacy and safety outcomes for patients receiving vancomycin therapy in an outpatient setting Results from this study will contribute to the development of an institutional, pharmacist-managed vancomycin protocol.
Methods: This is a single-center retrospective observational review. It will include patients aged 18 years or older transitioning from an inpatient setting to home having received vancomycin with a target trough of 15-20 mg/L between January 1, 2021, and December 31, 2021. To evaluate the primary objective of efficacy, the following data will be collected: days of therapy, reported troughs, patient specific doses, dose adjustments, and resolution of infection. To evaluate the secondary objective of safety, the following data will be collected: renal function throughout therapy, incidence of acute kidney injury (AKI) as defined in KDIGO guidelines, patient-specific doses, adverse drug reactions (ADRs) and premature discontinuation. Baseline characteristics to be collected include age, sex, race, dosing weight upon outpatient onboarding, renal function at initiation of therapy, predetermined comorbidities, indication, organism(s) identified on cultures, concomitant nephrotoxic therapies and mode of intravenous administration. Data will be obtained through this institution’s electronic medical records, de-identified, and maintained in a confidential manner. Data will be analyzed using descriptive statistics. This study was approved by the organization's Quality Review Board.