P3.S377: A Quality Improvement Project for using Parenteral Vancomycin in Pediatrics

Purpose/Objectives: Parenteral vancomycin treats gram-positive bacterial infections and requires therapeutic drug monitoring (TDM). In 2020, the Infectious Diseases Society of America endorsed TDM by using a ratio of area under the curve (AUC) over 24 hours to minimum inhibitory concentration (MIC), and updated empiric vancomycin dosing recommendations. In October 2023, our institution changed to AUC/MIC TDM from trough-only monitoring. We initiated quality improvement projects to educate providers about empiric dosing and the use of AUC/MIC TDM in children. We set goals to improve guideline consistent empiric dosing by 50%, and to achieve 70% of providers reporting comfort with empiric dosing and AUC/MIC TDM.

Design/Methods: Pre- and post-intervention chart reviews to evaluate empiric dosing and TDM outcomes were collected from December 2019 to June 2022 and from October 2023 to April 2024, respectively. In October 2023, in-person education was provided to the pediatrics department. From October through January 2024, providers throughout the institution completed computer-based training (CBT). Pre- and post-training surveys were completed using a Likert scale to assess provider comfort with empiric vancomycin dosing in children and AUC/MIC TDM. The survey was repeated 5 months later in the pediatrics department. Survey data was compared using Mann-Whitney U tests.

Results: Before intervention, 47 patients were prescribed parenteral vancomycin. 34% of orders were guideline consistent. Among patients with guideline consistent orders, 64% reached the trough goal on initial testing. Among 31 patients without guideline consistent orders, none reached a therapeutic trough initially. After intervention, 9 patients were prescribed parenteral vancomycin. 78% of orders were guideline consistent, demonstrating an improvement of 129%. 4 patients had guideline consistent orders and had AUC/MIC TDM completed at our institution. 75% of them reached the initial AUC/MIC goal.

In October 2023, 27 pediatricians received in-person training. Our survey demonstrated significant improvements in comfort after initial training and again 5 months later (p < 0.05) (Figure 1). At least 70% of the pediatricians reported comfort with 4 of the 5 survey items following in-person training. However, only 2 out of the 5 items were sustained after 5 months. From October 2023 to January 2024, 286 providers across the institution completed CBT. Although a significant improvement in comfort occurred (p < 0.05), it did so in less than 70% of these providers (Figure 2).

Conclusion/Discussion: In-person and computer-based training facilitate provider education on the use of parenteral vancomycin. Both training modalities showed statistically significant increases in provider comfort with vancomycin dosing and TDM. In-person training was more effective at reaching a goal of more than 70% of providers reporting comfort. Education improved guideline consistent empiric vancomycin dosing. Next steps include re-surveying providers, departmental refresher training, and follow-on outcome data analysis.