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Implementation and evaluation of vancomycin nomogram guidelines in a computerized prescriber-order-entry system

Lauren McCluggage, Kimberly Lee, Teresa Potter, Richard Dugger and Amy Pakyz

LAUREN MCCLUGGAGE, PHARM.D., BCPS, is Assistant Professor of Clinical Pharmacy, Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia, Philadelphia, PA; at the time of the study she was Pharmacy Practice Resident, Virginia Commonwealth University (VCU) Medical Center, Richmond. KIMBERLY LEE, PHARM.D., BCPS, is Antibiotic Management Team Pharmacist; TERESA POTTER, PHARM.D., M.P.H., BCPS, is Clinical Pharmacy Specialist—Internal Medicine; and RICHARD DUGGER, B.S., is Informatics Pharmacist, Department of Pharmacy Services, VCU Health System, Richmond. AMY PAKYZ, PHARM.D., M.S., BCPS, is Assistant Professor of Pharmacy, Department of Pharmacy, School of Pharmacy, VCU.

Address correspondence to Dr. McCluggage at the Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia, 600 South 43rd Street, Box 34, Philadelphia, PA 19104 (l.mccluggage@usp.edu).

Purpose. The implementation and evaluation of vancomycin nomogram guidelines in a computerized prescriber-order-entry (CPOE) system are described. Methods. Initial vancomycin orders for patients over age 18 years who received vancomycin between August 1 and September 30, 2006 (preimplementation), and between March 1 and April 30, 2007 (postimplementation), were compared with vancomycin nomogram recommendations to determine if the vancomycin regimen ordered coincided with the nomogram recommendation. The numbers of regimen changes and vancomycin serum concentrations measured during the first five days of therapy were also assessed. A multivariate logistic regression model assessed independent predictors of an initial vancomycin order that met the nomogram recommendation Results. A total of 522 vancomycin orders were included in the analysis (279 in the preimplementation group and 243 in the postimplementation group). A significant difference was observed in the percentage of initial vancomycin orders that met nomogram recommendations in the postimplementation group compared with the preimplementation group (36% versus 24%, p = 0.0028). No difference was noted between the two groups in the number of regimen changes or serum vancomycin concentrations measured during the first five days of therapy. In a multivariate analysis, age (p = 0.02) and weight (p with a vancomycin order that met nomogram recommendations, while the postimplementation group was positively associated with an order that met nomogram recommendations (p = 0.001). Conclusion. A vancomycin nomogram implemented into a CPOE system increased the likelihood of patients receiving an initial vancomycin regimen that coincided with the nomogram’s recommendations. Index terms: Antibiotics; Blood levels; Computers; Dosage; Medication orders; Methodology; Models; Nomograms; Protocols; Vancomycin

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