Objective

Vancomycin, a commonly used antimicrobial, has a narrow therapeutic index; therefore, Therapeutic Drug Monitoring (TDM) is required. Although the Electronic Medical Record (EMR) may improve patient care, without appropriate optimization, it can contribute to incorrectly drawn vancomycin levels. For medication administration, nurses utilize the Medication Administration Record (MAR) for medication administration documentation and medication workflow guidance. Therefore, we hypothesized creating a MAR level order which would be incorporated into this already established medication workflow may improve the rate of correctly drawn vancomycin levels.

Materials and Methods

This was a multicenter, retrospective, pre-and post-intervention study which evaluated the effect of a Medication Administration Record (MAR) level order within the EMR on the correct timing of vancomycin level collection. Vancomycin levels were classified into pre-and post-intervention groups. The primary endpoint was the rate of incorrectly drawn levels, defined as a level being drawn early, a level being drawn late, a level drawn while infusing, or a missed level.

Results

A total of 1353 vancomycin levels were assessed, and 628 levels met inclusion criteria. Of the levels eligible for inclusion, 331 were in the pre-intervention period and 297 were in the post-intervention period. Levels in the post-intervention group utilizing the vancomycin MAR level order were less likely to be missed or drawn at an incorrect time (11.1 % vs 36 %, P < 0.01) and were less likely to require rescheduling (3.4 % vs 8.5 %, P < 0.01).

Conclusion

Utilization of a vancomycin MAR level order was associated with a significant decrease in incorrectly drawn vancomycin levels.

中文翻译：

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利用万古霉素药物管理记录（MAR）水平顺序优化万古霉素水平收集的正确时机。

目的

万古霉素是一种常用的抗菌药物，其治疗指数较窄。因此，需要治疗药物监测（TDM）。尽管电子病历（EMR）可能会改善患者的护理水平，但如果没有适当的优化，则可能会导致错误绘制万古霉素水平。对于药物管理，护士利用药物管理记录（MAR）获取药物管理文档和药物工作流程指南。因此，我们假设创建一个MAR水平订单，该订单将被并入已经建立的药物工作流程中，可以提高正确抽取万古霉素水平的速度。

材料和方法

这是一项多中心，回顾性，干预前后的研究，评估了EMR中药物管理记录（MAR）水平顺序对万古霉素水平正确采集时间的影响。万古霉素水平分为干预前和干预后两组。主要终点是不正确绘制的级别的比率，定义为提早绘制的级别，提早绘制的级别，输注时绘制的级别或错过的级别。

结果

总共评估了1353个万古霉素水平，其中628个水平符合纳入标准。在符合纳入条件的水平中，有331个处于干预前阶段，有297个处于干预后阶段。使用万古霉素MAR水平顺序进行干预后组中的水平不太可能在不正确的时间错过或抽取（11.1％vs 36％，P <0.01），并且不太可能需要重新安排（3.4％vs 8.5％， P <0.01）。

结论

万古霉素MAR水平顺序的使用与不正确抽取的万古霉素水平的显着降低有关。