Aim To audit whether a new paediatric vancomycin guideline is being adhered to and if therapeutic levels are being achieved.
Method Data on doses, age, weight, vancomycin levels, time taken and renal function were collected prospectively by reviewing drug charts of paediatric patients on vancomycin. The patients were followed for their whole vancomycin journey in order to observe if the guidelines were followed throughout. Data were collected between 7th and 30th January 2015. The data were analysed using an excel spreadsheet.
Standards ▸ 100% of patients <1 month without renal failure should be prescribed an initial dose of 15 mg/kg three times a day
▸ 100% of patients ≥1 month without renal failure should be prescribed an initial dose of 20 mg/kg three times a day
▸ 100% of patients of all ages with renal impairment (defined as Glomerular filtration rate <50 ml/min) should be prescribed a single dose of 10 mg/kg
▸ 90% of patients should have their vancomycin levels taken at the correct time (pre-third dose)
▸ 80% of the third dose trough levels should be in range (10–15 mg/L)
▸ In 90% of patients with levels out of range, appropriate action should be taken to correct their levels.
Results Data from 15 patients were collected resulting in 62 vancomycin levels.
Three of six standards were met. Standards 1 and 3 could not be assessed as no patients were under the age of 1 month or had renal impairment. 100% patients were initiated on the correct staring dose meeting standard 2. One patient excluded from this standard as a clinical decision was made to start the patient on a lower starting dose of 15 mg/kg three times a day due to previous high levels. 90% of vancomycin levels had been taken at the correct time (pre-third dose) thus standard 4 was achieved. However there were 6 occasions when the levels were taken post-third dose or taken pre-maturely. These levels were not in range. Only 33% of patients had the initial level within range for standard 5; after a dose change a further 31% were in range.
For standard 6, 93% of actions taken by doctors when the vancomycin levels came back out of range were correct. This standard was achieved.
Conclusion This audit has shown that the guidelines are being followed but the paediatric dosing of vancomycin requires modification to achieve therapeutic levels. Limitations of the audit included low patient numbers, standard 1 and 3 could not be assessed and an assumption was made that all the levels documented were taken at the correct time, unless stated. Not enough data were collected to make suggestions based on different ages. An option would be to follow recommendation that frequency of dosing is changed from three to four times a day.1 A continuous infusion of vancomycin could also be considered.
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