This clinical audit and was conducted at a large teaching hospital NHS Trust from February to March 2014. Adult inpatients receiving vancomycin during the study period were identified by a list that was generated daily by the microbiology deportment. Paediatric patients, patients receiving haemodialysis,
patients admitting to a ward that does not follow guidelines, patients with missing data on dosing were excluded from this audit. Patients’; medical charts were reviewed and information about patient demographics, the nature of infection and vancomycin dosing and monitoring were collected using a pre-designed data collection form, which was designed according CHIR 99021 to a literature review, expert opinions and a pilot study. Descriptive Selleckchem Sotrastaurin statistics were used to describe the proportion of patients given the correct LD, correct MD, whose first PDL reached 10–20 mg/L. The time to maintaining within the therapeutic level was also calculated. This audit was conducted under the Trust’s research guidance and ethical approval was not required. Of the 104 eligible patients, 14 on dialysis, 8 from non-adherence wards and 5 had missing data were excluded. Of the 77 included patients, 55 (71.4%) were prescribed a LD according to guidelines; and 37 (67.3%) of the 54 patients were also prescribed a
MD according to guidelines. The overall adherence to the dosing guideline was 48.1%. Of the 37 patients whose LD and MD were prescribed correctly, 23 (62.2%) first PDL reached 10–20 mg/L. In contrast, of the 40 patients whose LD or MD was prescribed incorrectly, 21 (52.5%) patients’; first
PDL reached 10–20 mg/L. Sixteen (20.8%) of the 77 patients were excluded from the calculation for time to reach maintaining therapeutic Nutlin-3 manufacturer range due to missing data on dates and times for LD or only one PDL reading available. Of the 61 patients who had more than one PDL measure, 29 (47.5%) were given the correct LD and MD, and 14 (48.3%) of them maintained at the therapeutic level, and it took an average of 4.8 days to reach. Of the 32 patients given the incorrect LD or MD, only 10 maintained at the therapeutic level, it took 6.7 days to reach the level. Almost half of patients were prescribed vancomycin following the dosing guideline, and adherence to the guidelines increased the likelihood that therapeutic level was obtained and the therapeutic level was reached quicker. Further research is needed to explore reasons for non-adherence to vancomycin dosing guideline and evaluate the clinical outcomes related to appropriate dosing. R. Sivam, I. Sanghera, F. Turnbull Northwick Park Hospital, Harrow, UK The Nursing and Midwifery Council (NMC) ‘Standards for Medicines Management’ recommends that nurses should carry several checks before administering an injectable medicine. Only 51% (n = 90) of drug charts were documented with two signatures.