Joanne Oi Sze Chan1,2, Melissa Therese Baysari3, Jane Ellen Carland4, Indy Sandaradura5,6, Maria Moran4, Richard Osborne Day5,4. 1. School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia. z3459011@unsw.edu.au. 2. Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia. z3459011@unsw.edu.au. 3. Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia. 4. Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia. 5. School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia. 6. Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Entities:
Keywords:
Drug monitoring; Guidelines; Interview; Qualitative; Vancomycin
Authors: Timothy H Dellit; Robert C Owens; John E McGowan; Dale N Gerding; Robert A Weinstein; John P Burke; W Charles Huskins; David L Paterson; Neil O Fishman; Christopher F Carpenter; P J Brennan; Marianne Billeter; Thomas M Hooton Journal: Clin Infect Dis Date: 2006-12-13 Impact factor: 9.079
Authors: Michael Rybak; Ben Lomaestro; John C Rotschafer; Robert Moellering; William Craig; Marianne Billeter; Joseph R Dalovisio; Donald P Levine Journal: Am J Health Syst Pharm Date: 2009-01-01 Impact factor: 2.637
Authors: Stacy E F Melanson; Aleksandar S Mijailovic; Aileen P M Wright; Paul M Szumita; David W Bates; Milenko J Tanasijevic Journal: Am J Clin Pathol Date: 2013-12 Impact factor: 2.493
Authors: Daniel Livorsi; Amber R Comer; Marianne S Matthias; Eli N Perencevich; Matthew J Bair Journal: J Hosp Med Date: 2015-10-06 Impact factor: 2.960
Authors: Tanya Liv Zakrison; Brittany Rosenbloom; Amanda McFarlan; Aleksandra Jovicic; Sophie Soklaridis; Casey Allen; Carl Schulman; Nicholas Namias; Sandro Rizoli Journal: BMJ Qual Saf Date: 2015-11-06 Impact factor: 7.035
Authors: E Charani; E Castro-Sanchez; N Sevdalis; Y Kyratsis; L Drumright; N Shah; A Holmes Journal: Clin Infect Dis Date: 2013-04-09 Impact factor: 9.079
Authors: Tatjana Van Der Heggen; Franky M Buyle; Barbara Claus; Annemie Somers; Petra Schelstraete; Peter De Paepe; Sophie Vanhaesebrouck; Pieter A J G De Cock Journal: Int J Clin Pharm Date: 2021-04-28
Authors: Hasan M Al-Dorzi; Abdullah T Eissa; Raymond M Khan; Shmeylan A Al Harbi; Tarek Aldabbagh; Yaseen M Arabi Journal: Int J Health Sci (Qassim) Date: 2019 Jul-Aug
Authors: Rachel Constance Yager; Natalie Taylor; Sophie Lena Stocker; Richard Osborne Day; Melissa Therese Baysari; Jane Ellen Carland Journal: BMC Health Serv Res Date: 2022-04-18 Impact factor: 2.908