Vancomycin project reduces kidney injury, earns national recognition
Cincinnati Children’s was honored last month with the 2016 Award for Excellence in Medication Safety by the ASHP Foundation and the Cardinal Health Foundation. The award is the only national honor that recognizes a pharmacist-led interprofessional team for implementing significant institution-wide improvements in medication safety.
Josh Courter, PharmD, a clinical specialist in the medical center’s Antimicrobial Stewardship Program, is the pharmacist who spearheaded the effort in September 2015 as his I2S2 quality improvement project. He also drew on resources from the NINJA project (Nephrotoxic Injury Negated by Just-in-time Action), which was founded by Stuart Goldstein, MD, director, Center for Acute Care Nephrology, to assess medication plans for acute kidney injury risk.
“We wanted to encourage patient care teams to be more thoughtful about the antibiotics they prescribe,” says Courter. “Specifically, we required them to contact our Antimicrobial Stewardship Program when prescribing vancomycin for more than 4 days. We chose vancomycin because kids who take it for more than 4 days have an elevated risk of acute kidney injury.”
The project served as a timeout for the care teams where they could question whether the drug was still needed or if there was a potential alternative. By March 2016, the new process yielded data showing significant improvement – a 44-percent reduction in the number of times vancomycin therapy went longer than 4 days. There was also a decrease in the number of patients who developed acute kidney injury related to vancomycin – from an average of six children per week to four children per week.
Says David Haslam, MD, medical director, Antimicrobial Stewardship Program, “Kidney injury in children has life-long implications. If we can improve this outcome for our youngest patients, it will have a positive impact for a lifetime.”
At a ceremony held during the 2016 ASHP Midyear Clinical Meeting in Las Vegas, Courter and his team received $50,000, which they plan to use to sustain and build on the medical center’s medication safety infrastructure.
“Our Antimicrobial Stewardship Program has been focused on inpatients, but we hope to broaden that to the outpatient side,” says Courter. “Our door is open to anyone who wants our help, including community physicians.”
For more information about the program’s services, contact Courter at 513-803-3835 or Joshua.Courter@cchmc.org.
The Vancomycin Project Team
- Joshua Courter, PharmD, pharmacy clinical specialist – Antimicrobial Stewardship
- Dawn Butler, PharmD, pharmacy clinical coordinator
- David Haslam, MD, medical director, Antimicrobial Stewardship Program
- Jennifer Townsell, PharmD, pharmacy clinical specialist - Hematology/Oncology
- Matthew Zackoff, MD, chief resident
- Rajaram Nagarajan, MD, associate professor, Division of Oncology
- John Holcomb, quality improvement consultant, James M. Anderson Center
