Importance of Decision Support Implementation in Emergency Department Vancomycin Dosing

Brett Faine; Nicholas Mohr; Kari K Harland; Kathryn Rolfes; Blake Porter; Brian M Fuller

doi:10.5811/westjem.2015.4.25760

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Importance of Decision Support Implementation in Emergency Department Vancomycin Dosing

Journal article

Open access

Peer reviewed

Importance of Decision Support Implementation in Emergency Department Vancomycin Dosing

Brett Faine, Nicholas Mohr, Kari K Harland, Kathryn Rolfes, Blake Porter and Brian M Fuller

The western journal of emergency medicine, Vol.16(4), pp.557-564

07/2015

DOI: 10.5811/westjem.2015.4.25760

PMCID: PMC4530914

PMID: 26265968

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Abstract

The emergency department (ED) plays a critical role in the management of life-threatening infection. Prior data suggest that ED vancomycin dosing is frequently inappropriate. The objective is to assess the impact of an electronic medical record (EMR) intervention designed to improve vancomycin dosing accuracy, on vancomycin dosing and clinical outcomes in critically ill ED patients. Retrospective before-after cohort study of all patients (n=278) treated with vancomycin in a 60,000-visit Midwestern academic ED (March 2008 and April 2011) and admitted to an intensive care unit. The primary outcome was the proportion of vancomycin doses defined as "appropriate" based on recorded actual body weight. We also evaluated secondary outcomes of mortality and length of stay. The EMR dose calculation tool was associated with an increase in mean vancomycin dose ([14.1±5.0] vs. [16.5±5.7] mg/kg, p<0.001) and a 10.3% absolute improvement in first-dose appropriateness (34.3% vs. 24.0%, p=0.07). After controlling for age, gender, methicillin-resistant staphylococcus aureus infection, and Acute Physiology and Chronic Health Evaluation II score, 28-day in-hospital mortality (odds ratio OR 1.72; 95% CI [0.76-3.88], p=0.12) was not affected. A computerized decision-support tool is associated with an increase in mean vancomycin dose in critically ill ED patients, but not with a statistically significant increase in therapeutic vancomycin doses. The impact of decision-support tools should be further explored to optimize compliance with accepted antibiotic guidelines and to potentially affect clinical outcome.

Length of Stay

Medication Errors

Multivariate Analysis

Intensive Care Units

Staphylococcal Infections - drug therapy

Vancomycin - administration & dosage

Hospital Mortality

Humans

Middle Aged

Decision Support Systems, Clinical

Logistic Models

Male

Emergency Service, Hospital - organization & administration

Critical Illness - therapy

Adult

Female

Aged

Retrospective Studies

Methicillin-Resistant Staphylococcus aureus - isolation & purification

Anti-Bacterial Agents - administration & dosage

Electronic Health Records

Details

Title: Subtitle: Importance of Decision Support Implementation in Emergency Department Vancomycin Dosing
Creators: Brett Faine - University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
Nicholas Mohr - University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
Kari K Harland - University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
Kathryn Rolfes - University of Iowa College of Pharmacy, Iowa City, Iowa
Blake Porter - University of Iowa College of Pharmacy, Iowa City, Iowa
Brian M Fuller - Washington University, Department of Anesthesiology, St. Louis, Missouri
Resource Type: Journal article
Publication Details: The western journal of emergency medicine, Vol.16(4), pp.557-564
DOI: 10.5811/westjem.2015.4.25760
PMID: 26265968
PMCID: PMC4530914
NLM abbreviation: West J Emerg Med
ISSN: 1936-900X
eISSN: 1936-9018
Publisher: United States
Grant note: KL2 TR000450 / NCATS NIH HHS UL1 TR000448 / NCATS NIH HHS
Language: English
Date published: 07/2015
Academic Unit: Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
Record Identifier: 9984024541702771

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