Development and Implementation System of the Initial Dose Setting for Vancomycin in the Night Shift

Although accumulated evidence has shown the usefulness of the initial dosing setting for vancomycin, a gap exists between evidence and clinical practice, particularly in the night shift. The aim of this study was to fill the evidence-practice gap by using a newly developed procedure manual for planning the vancomycin dosing schedule and verifying the impact of the implementation of the initial dose setting for vancomycin. Twenty-five patients received an individual dose regimen using the present procedure (intervention group) and 23 patients who were taking the conventional dose by prescriber (non-intervention group) were enrolled in this study. Median (interquartile range: IQR) vancomycin serum trough concentration after 3 days of treatment was 12.1 μg/mL (10.1-15.3) for the intervention group, 9.5 μg/mL (5.6-15.0) for the non-intervention group. Clinical efficacy after 3 days of treatment was significantly superior in the intervention group(P = 0.004). Furthermore, the duration for 50% reduction of C-reactive protein and the duration for the reduction in body temperature to < 37°C were significantly shorter in the intervention group as compared with those in the non-intervention group. The incidence of vancomycin-induced nephrotoxicity tended to be lower (P = 0.24) in the intervention group than in the non-intervention group (0% versus 9%). In addition, the rate of initial dose setting in the night shift was significantly elevated after intervention (0% versus 70%, P < 0.001). These findings suggest that the present implementation system was useful for promotion of initial dose setting for vancomycin and improvement of patient's outcome.