Implementation and Evaluation of a Pilot Pharmacist-Led Vancomycin Therapeutic Drug Monitoring Service in an Acute General Hospital

To examine whether the pharmacist-managed vancomycin therapeutic drug monitoring (TDM) could optimize vancomycin dosage and monitoring. This was a retrospective cohort study with historical control. Serum vancomycin trough level (VANT) of patients treated with vancomycin under usual care from Sep 2014–Jan 2015 (historical control, CTRL) were compared to those treated with vancomycin therapy via a piloted pharmacist-managed TDM program from Sep 2015–Jan 2016 (intervention group, INTN). One hundred and six patients, 52 in INTN and 54 in CTRL, were included in the study. Of the 126 and 114 VANTs obtained from INTN and CTRL, 97 (77%) and 62 (54.3%) were regarded as appropriately timed trough concentrations for INTN and CTRL respectively (P < 0.001). VANT target achievement rate rose from 16.7% to 42.3% (NNT = 4, P = 0.005). Survival analysis showed the mean time to first VANT target achievement was shorter in INTN group, with 12.12 days and 33.8 days in INTN and CTRL respectively (HR = 4.873, P <0.001). Dosage adjustment when blood concentrations were outside VANT target were 50% and 62% in CTRL and INTN, respectively (P = 0.159). Rates of VANT rechecked after dosage adjustment was similar in both groups (INTN 76% vs CTRL 75%) (P = 0.916). The implementation of pharmacist-managed vancomycin therapeutic monitoring service across medical and orthopedics units significantly reduced the time to target VANT. Improvements can be seen in the increased proportion of patients achieving targeted VANT and reduced mistimed troughs.