Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Ali Taber, MD
Start Date
14-5-2025 11:30 AM
End Date
14-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background/Aim Statement: In the CICU empiric vancomycin is frequently prescribed. This practice occurs without broad knowledge of the actual rates of methicillin resistant staph aureus (MRSA) and methicillin resistant staph epidermidis (MRSE) infections. Given the potential for harmful side effects of vancomycin as well as concern for growing antibiotic resistance, we sought to better characterize local unit prescribing practices and MRSA/MRSE infection rates to guide our QI project with an aim of reducing vancomycin use in the CICU.
Methods (include PDSA cycles): Patient data from January 2021 to January 2023 was analyzed. The number of monthly days spent on vancomycin therapy ranged from 20 to 60 days. The mean vancomycin utilization ratio was 0.1 or 10%. In 2021 there were 111 orders for Vancomycin. Using a Pareto chart, we found that a majority (52) of Vancomycin orders were prescribed for fever alone. All positive cultures from 2021 were analyzed, and only 9.9 percent of the 111 vancomycin orders were prescribed as an entire treatment course for positive MRSA/MRSE infection. The aim of this QI project is to reduce the vancomycin utilization ratio from 0.1 to 0.075 by May 2025. Given the mismatch between prescribing habits and true infection rates, our first test of change will be to provide education regarding CICU MRSA/MRSE infection rates and current prescribing habits. Providers will be asked to not order vancomycin for fever alone without signs of hemodynamic instability and/or elevated inflammatory markers. The number of patients with MRSA/MRSE positive cultures that do not receive vancomycin prior to final culture results will be utilized as a balancing measure.
Results: Insufficient time has passed to evaluate the project’s first test of change.
Conclusions: Vancomycin is frequently empirically prescribed with low rates of MRSA/MRSE infections in the CICU. Our first test of change is to provide education on rates of MRSA/MRSE infections and vancomycin prescribing habits. We will be monitoring for a decrease in the vancomycin utilization ratio and MRSA/MRSE infections in which empiric therapy with vancomycin was missed.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Reducing Vancomycin Use in the CICU
Background/Aim Statement: In the CICU empiric vancomycin is frequently prescribed. This practice occurs without broad knowledge of the actual rates of methicillin resistant staph aureus (MRSA) and methicillin resistant staph epidermidis (MRSE) infections. Given the potential for harmful side effects of vancomycin as well as concern for growing antibiotic resistance, we sought to better characterize local unit prescribing practices and MRSA/MRSE infection rates to guide our QI project with an aim of reducing vancomycin use in the CICU.
Methods (include PDSA cycles): Patient data from January 2021 to January 2023 was analyzed. The number of monthly days spent on vancomycin therapy ranged from 20 to 60 days. The mean vancomycin utilization ratio was 0.1 or 10%. In 2021 there were 111 orders for Vancomycin. Using a Pareto chart, we found that a majority (52) of Vancomycin orders were prescribed for fever alone. All positive cultures from 2021 were analyzed, and only 9.9 percent of the 111 vancomycin orders were prescribed as an entire treatment course for positive MRSA/MRSE infection. The aim of this QI project is to reduce the vancomycin utilization ratio from 0.1 to 0.075 by May 2025. Given the mismatch between prescribing habits and true infection rates, our first test of change will be to provide education regarding CICU MRSA/MRSE infection rates and current prescribing habits. Providers will be asked to not order vancomycin for fever alone without signs of hemodynamic instability and/or elevated inflammatory markers. The number of patients with MRSA/MRSE positive cultures that do not receive vancomycin prior to final culture results will be utilized as a balancing measure.
Results: Insufficient time has passed to evaluate the project’s first test of change.
Conclusions: Vancomycin is frequently empirically prescribed with low rates of MRSA/MRSE infections in the CICU. Our first test of change is to provide education on rates of MRSA/MRSE infections and vancomycin prescribing habits. We will be monitoring for a decrease in the vancomycin utilization ratio and MRSA/MRSE infections in which empiric therapy with vancomycin was missed.
