Barriers and facilitators of appropriate vancomycin use: prescribing context is key

Joanne Oi Sze Chan*, Melissa Therese Baysari, Jane Ellen Carland, Indy Sandaradura, Maria Moran, Richard Osborne Day

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Purpose: Audit studies reveal frequent non-compliance with dosing and monitoring guidelines for vancomycin. This study aimed to qualitatively explore the barriers and facilitators of compliance with vancomycin dosing and monitoring guidelines. Methods: Interviews were conducted with 16 prescribers in a large tertiary teaching hospital in Sydney, Australia. Questions explored knowledge, attitudes, and perceived complexities associated with vancomycin use. Interviews were analysed using thematic analysis. Results: Prescribers reported utilising vancomycin guidelines, citing familiarity with guidelines, a positive perception of guidelines, awareness of poor guideline compliance, and assistance from specialist staff as facilitators of the uptake of guideline recommendations. Barriers existing within the prescribing environment such as the prescribing culture, a lack of time, and poor communication and coordination of therapeutic drug monitoring processes were identified as hindrances to guideline compliance. Conclusions: The provision of guidelines may not be sufficient in ensuring appropriate prescribing and monitoring of vancomycin when barriers relating to the prescribing environment exist. Developing interventions targeted toward these barriers, such as having dedicated phlebotomists for vancomycin blood sampling, fostering better handover processes, and educating staff on poorly understood aspects of guidelines, is likely to improve the uptake of guideline recommendations for vancomycin and other medications requiring therapeutic drug monitoring.

Original languageEnglish
Pages (from-to)1523–1529
Number of pages7
JournalEuropean Journal of Clinical Pharmacology
Volume74
Issue number11
Early online date28 Jul 2018
DOIs
Publication statusPublished - Nov 2018

Keywords

  • Drug monitoring
  • Guidelines
  • Interview
  • Qualitative
  • Vancomycin

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