JAC Advance Access originally published online on August 2, 2005
Journal of Antimicrobial Chemotherapy 2005 56(3):566-568; doi:10.1093/jac/dki279
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Improved compliance with a gentamicin prescribing policy after introduction of a monitoring form
1 Department of Microbiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry & Warwickshire Hospital, Stoney Stanton Road, Coventry CV1 4FH, UK; 2 Department of Microbiology, South Manchester University Hospitals NHS Trust, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; 3 Department of Pharmacy, Salford Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK; 4 Department of Microbiology, Salford Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK
Received 15 December 2004; returned 7 February 2005; revised 12 July 2005; accepted 14 July 2005
* Corresponding author. Tel: +44-161-291-2885; Fax: +44-161-291-4755; E-mail: Mairi.Cullen{at}smuht.nwest.nhs.uk
Objectives: Compliance with our local hospital policy for gentamicin administration and monitoring was found to be inadequate on audit. A gentamicin monitoring form was introduced with the aim of improving staff compliance with the policy thus minimizing the risks of toxicity while ensuring adequate dosing.
Patients and methods: The initial audit examined the prescribing, administration and monitoring of intravenous gentamicin given to 20 patients. The introduction of a gentamicin monitoring form was prompted by unsatisfactory initial dosing and subsequent monitoring and adjustment of gentamicin doses.
Results: Following introduction of the monitoring form, the proportion of appropriate starting doses had increased from 13 out of 20 to 18 out of 20 prescriptions. The timing of initial serum levels was significantly better: 18 timed correctly, compared with 12 in initial audit. Subsequent administration and monitoring appeared more compliant with fewer doses inappropriately omitted and more levels checked appropriately. No improvement was seen in the quality of dose adjustment.
Conclusions: In conjunction with the support and advice of the pharmacy and microbiology departments, the use of a gentamicin monitoring form can improve the quality of intravenous gentamicin use in the hospital setting.
Keywords: nephrotoxicity , pharmacists , algorithm