Model for effective monitoring of patients receiving aminoglycoside antibiotic therapy

Monitoring a patient's serum aminoglycoside levels is essential for reaching therapeutic levels of the drug while avoiding the adverse consequence of nephrotoxicity. In 1985, aminoglycoside testing at the University of Utah Health Sciences Center was evaluated by a pharmacy resident who reported that some patients had excessive numbers of tests performed while others experienced inadequate monitoring. A committee was established to examine this perceived problem. The committee developed guidelines for aminoglycoside use which identified patients needing to be monitored and the number of levels to be performed. A new laboratory-ordering worksheet was designed to resolve specimen collection problems. Data collected on 146 patients, 71 prior to and 75 following implementation of the guidelines, were evaluated to assess the difference in the ordering patterns. In each group, PRE and POST, there were 50 patients who met the guideline criteria for being monitored. Serum creatinine levels were evaluated to assess compliance with the guidelines which recommended that they be performed every three to four days during therapy as an indicator of aminoglycoside-associated nephrotoxicity. A significant (P<.05) improvement in the ordering pattern for serum levels at 72 hours resulted after the guidelines were implemented. No change was seen in the ordering pattern of weekly serum levels. There was an 9% PRE and a 14% POST incidence of aminoglycoside-associated nephrotoxicity. The laboratory-ordering worksheets were submitted with 59% of the serum levels ordered and, when available, aided in the resolution of the problems. All hospital departments involved with aminoglycoside therapy had influence and control over the final solutions which aided in their acceptance of changes.