{
  "abstract": "Aim Vancomycin is a frequently used anti-infective agent in the Paediatric Intensive Care Unit (PICU), particularly for the treatment of serious Gram-positive infections. Due to its narrow therapeutic index, therapeutic drug monitoring is essential to optimise efficacy while minimising the risk of toxicity. 1 2 Vancomycin has been a recurring theme at PICU clinical governance meetings, largely due to the high frequency of incident reports related to its prescribing and monitoring. This audit aimed to evaluate compliance with the hospital guideline1 for the prescribing and monitoring of intermittent intravenous vancomycin in PICU.Method A retrospective audit was conducted reviewing vancomycin prescriptions for patients admitted into PICU from November to December 2023. The audit was approved by the Trust Clinical Audit Committee. Ethics approval was not required. All patients who received vancomycin during this period were included. Data was extracted from Phillips ICCA (IntelliSpace Critical Care and Anesthesia) prescribing system for prescription records and vancomycin trough levels. Data was analysed to identify the percentage of patient that followed the initial dosing guidance as per the trust guideline; percentage of patients that had a trough level checked at 24 hours (toxicity check) and actioned appropriately; percentage of patients who had a trough level checked at 48 hours (therapeutic check) and actioned appropriately (i.e. <15mg/L continue at current dose, >15mg/L treat as a high level and follow protocol); and the percentage of patients on vancomycin for >48 hours that reached their target therapeutic range.Results 19 vancomycin treatment courses from 16 patients were reviewed. 89% of patients started on vancomycin followed the initial dosing guidance in the trust protocol.1 100% of patients on vancomycin had a level checked at 24 hours (toxicity check) which was actioned appropriately. 52% of patients on vancomycin had a level checked at 48 hours (therapeutic check) and 42% of patients with a therapeutic check were actioned appropriately. 74% of patients on vancomycin for >48 hours reached their target therapeutic range.Conclusion The audit demonstrated that the target rate for initial dosing based on the guideline was not achieved, mainly due to omission of the loading dose specified for children aged 12–17 years. The 24-hour toxicity monitoring with appropriate action showed high compliance with the guideline. However, adherence to 48-hour therapeutic level checks with appropriate actions was suboptimal. These findings highlight the need for improved compliance with ongoing monitoring to ensure safe and effective vancomycin use in PICU. The audit also showed there is still room for improvement in achieving target ranges. Following discussion at the PICU Quality and Safety Improvement Meeting (PQSIP), recommendations included: improving guideline usability involving doctors, pharmacists, and nurses; reviewing the ICCA standard order for the 12–17 year age group to potentially include a stat loading dose; improving visibility of levels due on the ICCA drug chart using colour highlights; and incorporating vancomycin reviews into the daily microbiology ward round to ensure timely level checks and appropriate dosing plans. Following implementation of these recommendations, a re-audit will be conducted.References Gray J, Wade S. Vancomycin- intermittent intravenous vancomycin for paediatric patients. Internal trust guideline.2024.Patel J, Lucas C, Ryan J, et al. Vancomycin therapeutic drug monitoring in paediatrics. Paediatr Child Health 2020;56:563–570.",
  "authors": [
    {
      "affiliations": [
        "Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, UK"
      ],
      "name": "Mariam Gebahi"
    },
    {
      "affiliations": [
        "Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, UK"
      ],
      "name": "Mohamed Elsayed"
    },
    {
      "affiliations": [
        "Royal United Hospitals Bath NHS Foundation Trust, UK"
      ],
      "name": "Jane Hutchinson-Jones"
    }
  ],
  "title": "P32 Vancomycin prescribing on paediatric intensive care: are we getting it right?",
  "uid": "40f92b18-4f01-5412-bdeb-024500cccc85"
}