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PS-073 Clinical impact of pharmacist intervention in therapeutic vancomycin monitoring
  1. AM Sánchez García1,
  2. A Andújar Mateos2,
  3. A Martí Llorca2,
  4. C Matoses Chirivella2,
  5. FJ Rodríguez Lucena2,
  6. A Navarro Ruiz2
  1. 1Hospital General Universitario de Elche, Elche, Spain
  2. 2Hospital General Universitario de Elche, Pharmacy, Elche, Spain


Background The unit dose drugs dispensing system (UDDDS) is established in the following way: first, the physician prescribes the treatment for the patient, the pharmacist then validates the prescription and finally the medication is dispensed from the pharmacy department. One function on the UDDDS is review the inpatient’s pharmacotherapeutic profile and recommend therapeutic drug monitoring, such as vancomycin plasma levels. Vancomycin is an antimicrobial glycopeptide with high toxicity whose most important adverse reactions are the red man syndrome, ototoxicity and nephrotoxicity.

Purpose To evaluate the clinical impact of pharmaceutical interventions from the UDDDS in the recommendation of vancomycin plasma levels in hospitalised patients and subsequent dosage adjustment from the pharmacokinetic unit.

Material and methods Descriptive and prospective study, conducted between January and August 2015 in a teaching care hospital of 412 beds. We reviewed all of the monitoring recommendations carried out in adult inpatients with a vancomycin prescription order. Critically ill patients were excluded.

From the UDDDS of the pharmacy service, the recommendations had been made taking into account if the patient did not have vancomycin plasma levels measured or ordered. We analysed physician agreement with these recommendations, and patients who had adequate concentrations (appropriate range considering both 10–15 µg/mL and 15–20 µg/mL as severe infections) or doses adjusted by the pharmacist.

Results During the study period, the recommendation for vancomycin monitoring was performed in 112 patients after reviewing their pharmacotherapeutic profile, of which 64 were accepted (57.14%). 143 patients treated with vancomycin were monitored from the pharmacokinetic unit, so that 44.75% were performed following the recommendation from the UDDDS. Of these, 22 (34.38%) were within the therapeutic range and in 42 (65.62%) the pharmacist recommended a new dosing regimen tailored to the patient’s clinical condition.

Conclusion The pharmaceutical intervention from the UDDDS in the recommendation of vancomycin plasma levels in inpatients allowed correct dosage in more than half of the patients.

No conflict of interest.

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