A vancomycin monitoring program at a community hospital.

BACKGROUND: Because of concern about patients' increased risk of developing resistance to vancomycin, a vancomycin monitoring program involving education, not restriction, on the prudent use of vancomycin was developed at the Barnes-Jewish Christian (BJC) North Region hospitals in St Louis. The program was spearheaded by the pharmacy department and monitored by interdisciplinary committees within the hospital. METHODS: An educational note based on a Centers for Disease Control and Prevention (CDC) guideline for prudent use of vancomycin was prepared and placed in patient charts by a designated pharmacist. This intervention was tracked along with the medical staff's response to the note. In a one-year period, the rate of appropriate use of vancomycin increased from 59% to 80% (p < 0.01), whereas the number of care interventions involving vancomycin usage decreased by approximately 75%. DISCUSSION: A community hospital can promote appropriate use of antibiotics, in this case vancomycin. The fact that the rate at which vancomycin was appropriately prescribed increased and the number of pharmacist interventions (notes) decreased suggests that the vancomycin note reminders and related educational material were successful. Although these numbers do not represent 100% compliance, treatment with vancomycin may have been clinically appropriate for some of the cases even if the situation was not listed as an appropriate use in the CDC guideline. CONCLUSION: The vancomycin monitoring program, which represents a simple means of intervening and maintaining continuous monitoring and quality improvement in a clinical area, continues at the BJC North Region hospitals.

Pegaspargase versus asparaginase in adult ALL: a pharmacoeconomic assessment.

Asparaginase is an effective treatment for patients with acute lymphocytic leukemia (ALL). Unfortunately, asparaginase therapy is associated with a high incidence of hypersensitivity reactions (up to 73%), including life-threatening anaphylaxis, and its half-life of approximately 20 hours necessitates daily administration. Pegaspargase, a modification of L-asparaginase, has a longer half-life (357 hours), a decreased incidence of hypersensitivity reactions, and when doses every 14 days, provides comparable efficacy to asparaginase; however, it is much more expensive per single-dose vial ($980.00 vs $52.38). To determine the pharmacoeconomic impact of the two agents, we conducted a cost-minimization analysis for three common adult ALL protocols. Results showed that pegaspargase was significantly less costly to payers on an inpatient or outpatient basis and warranted addition to our formulary.

Pharmacy residency training programs: a resident's perspective.

As changes are being made in the health care system, the roles and responsibilities of the pharmacist are evolving in direct patient care. The knowledge and skills necessary to succeed in these clinical positions are obtained through postgraduate training through pharmacy practice and specialty residencies and fellowships. Residency candidates are faced with important decisions in choosing which training programs to select and planning the course of the training. This article approaches the questions and decision-making process in residency selection from pharmacy residents' points of view.