Background Vancomycin is a drug with a narrow therapeutic range, in which accurate data on weight or renal function are indispensable for correct practice.

Purpose To analyse the minimum set of data necessary for a correct follow-up of patients on vancomycin treatment and to assess whether therapeutic drug monitoring (TDM) by the pharmacy service improves the quality of the data recorded in the electronic medical record (EMR).

Material and methods A retrospective clinical practice study of the case series treated with vancomycin and subsequently TDM or not during the period from 1 January 2016 to 31 December 2016.

Following data was collected: TDM (yes/no), age, weight, creatinine at baseline and at the end, and Protein C Reactive (PCR) at the beginning and at the end. The data have been extracted from the EMR through the Selene^®program and we used descriptive statistic using the SPSS^® V23 program.

Results Of the 264 patients treated with vancomycin, in 35% of them weight was not completed in EMR. 1.5% of the patients of the TDM group had not recorded the weight in EMR compared to 45% of patients of the non-TDM group (p<0.0001).

Before the start of treatment with vancomycin, 5% of the patients had no creatinine data. None of them belonged to the TDM group versus 6.5% that belonged to the non-TDM group (p=0.0328).

Thirteen per cent did not reflect the value of PCR at the start: 6.1% of the TDM group versus 15.6% of the non-TDM group (p=0.0315).

At the end of treatment, 29.9% had not completed the PCR value (13.79% of the TDM group versus 55.90% of the non-TDM group) and 18.2% did not request the creatinine value: none of them belonged to the TDM group and 32% to the non-TDM group.

Conclusion TDM by the pharmacist improves the quality of the data recorded in the EMR. Its implication in the follow-up of the patients ensures that the necessary data for the correct dosage and monitoring of the toxicity and effectiveness of the treatments are completed.

References and/or Acknowledgements Thanks to my service for your unconditional support

No conflict of interest