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Preauthorization policy failed to reduce unnecessary vancomycin use in pediatric hospital
Implementation of a preauthorization policy did not significantly decrease the use of vancomycin beyond that achieved with a prospective-audit and feedback policy at a tertiary pediatric teaching hospital, according to study results.
An antimicrobial stewardship program was implemented in 2004 at the Alfred I. DuPont Hospital for Children in Wilmington, Delaware. The program incorporated antibiotic indications for vancomycin as a mandatory field in the institutional computerized physician/prescriber order entry, according to background information in the study.
For the purpose of further reducing unnecessary vancomycin use, the hospital’s policy was modified, requiring preauthorization beyond two doses.
Shannon Chan, PharmD, of the department of pediatrics at the hospital, and colleagues sought to assess the effect of the two consecutive antimicrobial stewardship interventions on vancomycin use at their institution. The researchers calculated monthly vancomycin use as doses administered per 1,000 patient-days.
According to study results, vancomycin use decreased 45% after 5 years of the audit, from 378 doses administered per 1,000 patient-days to 208 doses per 1,000 patient-days. After preauthorization implementation, researchers observed an additional 16% decrease in the use of vancomycin during the following 4 years.
However, there was an increase in vancomycin use after the implementation of the restriction policy by 3.9 doses per month (P=.012) during the subsequent 51 months.
“The modification of the institution’s vancomycin policy requiring preauthorization by an infectious diseases physician led to a decrease in the mean number of vancomycin doses administered, but on regression analysis, the trend of vancomycin use was not statistically improved beyond the achievements of prospective audit with direct interaction and feedback to prescriber,” Chan and colleagues wrote. “Institutions should carefully assess the impact of different Antimicrobial Stewardship Programs interventions and use strategies that would result in the best yield based on careful assessment of their needs and resources.”
Disclosure: The researchers report no relevant financial disclosures.