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An audit of adherence to the neonatal unit antimicrobial policy for gentamicin prescribing and suitability of dose-banding recommendations for different postmenstrual age groups
  1. L McClenahan
  1. Chelsea and Westminster NHS Foundation Trust, London, UK

Abstract

Objective To re-audit compliance with the neonatal unit antimicrobial policy for gentamicin prescribing, including dosing interval and trough level monitoring, and to assess suitability of dose-banding recommendations for different postmenstrual age groups following changes to the policy to reflect BNF for children dosing guidance.1 2

Method The data collection tool from a previous audit was adapted and piloted prior to data collection over an 8-week period. Both retrospective and prospective data was collected for all patients prescribed gentamicin on the neonatal unit at that time.

Results In total 68 courses of gentamicin were prescribed for 61 patients, with 218 gentamicin doses and 130 trough levels audited. 100% of neonates were prescribed gentamicin for the correct indication in line with the neonatal unit antimicrobial policy. 100% of doses were recorded on the drug chart, and 96% (210/218) were prescribed correctly. Of the 4% (8/218) prescribed incorrectly, one patient was prescribed gentamicin twice daily, three patients received doses at 24 h after elevated trough levels and one patient 33 h after, rather than at the recommended 36 h. One dose was calculated incorrectly and one was given 6 h early. The dose for a patient with renal impairment was not reduced from 7 mg/ kg to 5 mg/kg.

Of the 130 trough levels audited, 31 (24%) were taken late and 10 (7%) were taken early. One level (1%) was not clearly documented on the drug chart. Thirty-six (28%) out of 130 trough levels sampled were recorded as high (≥2 mg/l), and 11 (31%) of these high levels were not re-measured at the correct sampling time. Of the 36 high trough levels, 32 (89%) were reported in the 32 week to 1 month postmenstrual age group (n=40), 3 (8%) in the 1–6 month group (n=4) and 1 (3%) in the <32 week group (n=17). Within the 32 week to 1 month group, 75% (24/32) of the recorded high trough levels were reported within the 32–36 week postmenstrual age group.

Conclusion There has been a drop in standards since the previous audit, which achieved 100% compliance with the gentamicin policy for both prescribing and monitoring. When the NPSA's care bundle on ‘safer prescribing of gentamicin in neonates’ is fully implemented by Feb 2011, prescribing and monitoring are expected to improve. A rolling audit will then be carried out to assess compliance with the care bundle.

Thirty-six out of 130 trough levels sampled were recorded as high, and 75% (24/32) of these high levels were in the 32–36 week postmenstrual age group. Prior to this audit there had been concerns that the 32–34 week postmenstrual age group were experiencing a high number of elevated trough levels following a change in dosing guidance from 36 to 24 hourly. From the results it appears that the dosing guidance for the 32–36 week postmenstrual age group warrants further discussion and investigation to ensure dosing is suitable.

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