Barriers and facilitators of appropriate vancomycin use: prescribing context is key
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Audit studies reveal frequent non-compliance with dosing and monitoring guidelines for vancomycin. This study aimed to qualitatively explore the barriers and facilitators of compliance with vancomycin dosing and monitoring guidelines.
Interviews were conducted with 16 prescribers in a large tertiary teaching hospital in Sydney, Australia. Questions explored knowledge, attitudes, and perceived complexities associated with vancomycin use. Interviews were analysed using thematic analysis.
Prescribers reported utilising vancomycin guidelines, citing familiarity with guidelines, a positive perception of guidelines, awareness of poor guideline compliance, and assistance from specialist staff as facilitators of the uptake of guideline recommendations. Barriers existing within the prescribing environment such as the prescribing culture, a lack of time, and poor communication and coordination of therapeutic drug monitoring processes were identified as hindrances to guideline compliance.
The provision of guidelines may not be sufficient in ensuring appropriate prescribing and monitoring of vancomycin when barriers relating to the prescribing environment exist. Developing interventions targeted toward these barriers, such as having dedicated phlebotomists for vancomycin blood sampling, fostering better handover processes, and educating staff on poorly understood aspects of guidelines, is likely to improve the uptake of guideline recommendations for vancomycin and other medications requiring therapeutic drug monitoring.
KeywordsVancomycin Guidelines Qualitative Interview Drug monitoring
We wish to acknowledge the participation and contribution of all the doctors interviewed in this study. In addition, we would like to thank Dr. Emma Tay for her help in participant recruitment.
JOC helped acquire, analyse, and interpret the data and drafted the article. MTB and ROD conceived and designed the study, helped analyse and interpret the data, and revised the article for publication. JEC, IS, and MM helped interpret the data and revised the article for publication. All authors had full access to all of the data and can take responsibility for the integrity of the data and the accuracy of the data analysis and had final approval of the version to be published.
This study was funded by the National Health and Medical Research Council Program (grant number 1054146).
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Rybak M, Lomaestro B, Rotschafer JC et al (2009) Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 66:82–98. https://doi.org/10.2146/ajhp080434 CrossRefPubMedGoogle Scholar
- 9.Jeffres MN, Isakow W, Doherty JA et al (2007) A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumonia. Clin Ther 29:1107–1115. https://doi.org/10.1016/j.clinthera.2007.06.014 CrossRefPubMedGoogle Scholar
- 13.Dellit TH, Owens RC, McGowan JE et al (2007) Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44:159–177. https://doi.org/10.1086/510393 CrossRefPubMedGoogle Scholar
- 18.Diasinos N, Baysari M, Kumar S et al (2015) Does the availability of therapeutic drug monitoring, computerised dose recommendation and prescribing decision support services promote compliance with national gentamicin prescribing guidelines? Intern Med J 45:55–62. https://doi.org/10.1111/imj.12627 CrossRefPubMedGoogle Scholar
- 30.Antibiotic Expert Group (2016). Therapeutic Guidelines: Antibiotic (Version 15). https://tgldcdp.tg.org.au/guideLine?guidelinePage=Antibiotic&frompage=etgcomplete. Accessed 26 January 2018
- 31.Lapadat JC (2010) Thematic analysis. In: Mills AJ, Durepos G, Wiebe E (eds) Encyclopedia of case study research. SAGE Publications, Inc., California, pp 925–927Google Scholar