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  • Quality Improvement Article
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Continuous infusion of vancomycin improved therapeutic levels in term and preterm infants

Journal of Perinatology volume 41, pages 1459–1466 (2021)Cite this article

Subjects

Abstract

Background

Growing evidence suggests that continuous infusion of vancomycin (CIV) is superior to intermittent infusion of vancomycin (IIV) in neonates. This quality improvement (QI) project aimed to transition from IIV to CIV with earlier and improved attainment of therapeutic vancomycin levels.

Methods

The Model for Improvement framework with Plan Do Study Act cycles was used. Prospective data were collected during three phases: IIV, CIV-1 and CIV-2.

Interventions

A QI team developed a CIV drug monograph and a multidisciplinary education package.

Results

Using IIV, 36% (9/25) of first vancomycin levels were within target range. CIV achieved therapeutic levels twice as quickly as IIV (p < 0.05) with improved first vancomycin target levels (IIV 36%, 9/25; CIV-1 55%, 16/29; CIV-2 61%, 14/23) and total therapeutic levels (IIV 44%, 37/84; CIV-1 56%, 55/98; CIV-2 69%, 79/114).

Conclusions

This QI project demonstrated a successful transition from IIV to CIV with reduced time to achieve target vancomycin and an increased proportion of therapeutic levels.

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Fig. 1: Summary of continuous infusion of vancomycin monograph and therapeutic drug monitoring schedule.
Fig. 2: Plan Do Study Act (PDSA) diagram summarising the actions involved in each stage of the project.

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Acknowledgements

We would like to thank the Clinical Audit Department of University Hospitals of Leicester NHS Trust in their support of this work.

Author information

Authors and Affiliations

  1. Leicester Medical School, George Davies Centre, Leicester, UK

    Antonia Round & Emily Clifton

  2. Pharmacy Department, Leicester Royal Infirmary, Leicester, UK

    Lucy Stachow

  3. Neonatal Intensive Care Unit, Leicester Royal Infirmary, Leicester, UK

    Sumit Mittal, Kamini Yadav & Ranveer Singh Sanghera

  4. Paediatric Department, Leicester Royal Infirmary, Leicester, UK

    Hira Ashraf

  5. Paediatric Infectious Diseases and Immunology Department, Bristol Royal Hospital for Children, Bristol, UK

    Khuen Foong Ng

Authors
  1. Antonia Round
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  2. Emily Clifton
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  7. Ranveer Singh Sanghera
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  8. Khuen Foong Ng
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Contributions

KFN and SM contributed to the conception of the project. All listed authors contributed to the acquisition of data. AR initially drafted the paper, with KFN subsequently editing. All authors were then involved in revising and final approval of the paper. All authors agree to be accountable for all aspects of the work and its integrity.

Corresponding author

Correspondence to Antonia Round.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This quality improvement project was approved by the UHL Clinical Audit Department. Audit registration number was 10080.

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Round, A., Clifton, E., Stachow, L. et al. Continuous infusion of vancomycin improved therapeutic levels in term and preterm infants. J Perinatol 41, 1459–1466 (2021). https://doi.org/10.1038/s41372-020-00909-3

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  • DOI: https://doi.org/10.1038/s41372-020-00909-3

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