CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.
Intervention to improve timing of vancomycin levels
Samples drawn for therapeutic drug monitoring are sometimes drawn too early, which can cause inaccurate results that lead to a potential dosing error. One approach to reducing such errors is to create an information technology tool to assist clinicians in determining the best timing for a sample draw. The authors conducted a study at Brigham and Women’s Hospital, Boston, in which the investigators used both an educational and electronic intervention to reduce the number of vancomycin collection timing errors. The information technology-based intervention provided educational instructions to nurses. The authors then determined, for 27 months before and 14 months after the intervention, the percentages of levels drawn too early. They also conducted interviews with nurses and investigated the cause of the mistimed collected levels. The authors discovered that the percentage of vancomycin timing errors decreased from 39 percent to 32 percent, but this decrease was not statistically significant using time series analysis. The study also found that only 33 percent of the nurses used the instructions provided as an educational reminder, despite the requirement to acknowledge receipt of the instructions in the electronic medication administration record. A common error resulted when some of the nurses timed the levels too early or delayed the next vancomycin dose until the levels were reported. Phlebotomy draws were also associated with a higher rate of early vancomycin levels. The authors noted the importance of communicating appropriate level timing with care team members who are not ordering or scheduling vancomycin levels. To improve workflow and reduce errors, the authors suggested the need for the electronic medical record to adjust the originally scheduled time for the vancomycin dose when the previous dose was given later than anticipated. They also recommended developing an information technology solution that would integrate various IT subsystems, including computerized provider order entry, medication administration, specimen collection, and the laboratory information system.
Melanson SEF, Mijailovic AS, Wright APM, et al. An intervention to improve the timing of vancomycin levels. Am J Clin Pathol. 2014;140:801–806.
Correspondence: Dr. Stacy Melanson at semelanson@partners.org