Optimizing the correct timing of vancomycin level collection utilizing a vancomycin medication administration record (MAR) level order. (November 2020)

• Record Type: Journal Article
• Authors: Shah, Sunish; Rouse, Ginger E.; McManus, Dayna; Tichy, Eric M.; DeVaux, Laura; Hutchins, Leslie; Topal, Jeffrey E.
• Is Part Of: International journal of medical informatics. Volume 143(2020)
• Publication Date: 2020-11
• Subjects: Vancomycin -- Medication administration record -- Electronic medical record -- Drug level; Medical informatics -- Periodicals; Information science -- Periodicals; Computers -- Periodicals; Medical technology -- Periodicals; Medical Informatics -- Periodicals; Technology, Medical -- Periodicals; Computers; Information science; Medical informatics; Medical technology; Electronic journals; Periodicals; Electronic journals; 610.285
• DOI: 10.1016/j.ijmedinf.2020.104249
• Languages: English
• ISSNs: 1386-5056

Abstract

Highlights: Vancomycin requires therapeutic drug monitoring given the drug's narrow therapeutic index. Obtainment of serum levels for therapeutic drug monitoring is challenging and levels are frequently missed or drawn at an inappropriate time. This study identified that utilization of a vancomycin MAR level order was associated with a decrease in incorrectly drawn vancomycin levels. Use of a MAR level may be able to be extrapolated to other medications that require therapeutic drug monitoring. Abstract: Objective: Vancomycin, a commonly used antimicrobial, has a narrow therapeutic index; therefore, Therapeutic Drug Monitoring (TDM) is required. Although the Electronic Medical Record (EMR) may improve patient care, without appropriate optimization, it can contribute to incorrectly drawn vancomycin levels. For medication administration, nurses utilize the Medication Administration Record (MAR) for medication administration documentation and medication workflow guidance. Therefore, we hypothesized creating a MAR level order which would be incorporated into this already established medication workflow may improve the rate of correctly drawn vancomycin levels. Materials and Methods: This was a multicenter, retrospective, pre-and post-intervention study which evaluated the effect of a Medication Administration Record (MAR) level order within the EMR on the correct timing of vancomycin level collection. Vancomycin levels were classified into pre-and post-intervention groups. The primary endpoint was the rate of incorrectly drawn levels, defined as a level being drawn early, a level being drawn late, a level drawn while infusing, or a missed level. Results: A total of 1353 vancomycin levels were assessed, and 628 levels met inclusion criteria. Of the levels eligible for inclusion, 331 were in the pre-intervention period and 297 were in the post-intervention period. Levels in the post-intervention group utilizing the vancomycin MAR level order were less likely to be missed or drawn at an incorrect time (11.1 % vs 36 %, P < 0.01) and were less likely to require rescheduling (3.4 % vs 8.5 %, P < 0.01). Conclusion: Utilization of a vancomycin MAR level order was associated with a significant decrease in incorrectly drawn vancomycin levels.