Reappraisal of therapeutic vancomycin trough concentrations with empirical dosing in neonatal infections.

BACKGROUND: Vancomycin is commonly used for neonatal sepsis. However, consensus on an empirical neonatal vancomycin regimen remains uncertain. We aimed to reappraise the therapeutic optimum concerning vancomycin trough concentrations with empirical dosing and to evaluate the relationship between trough concentrations and predicted 24-h area under the curve (AUC24). METHODS: This was a 3-year retrospective study. Neonates who were admitted to the neonatal intensive care unit with available vancomycin trough concentrations were enrolled. Trough levels were obtained before the fourth dose. Achievement of goal trough after implementing the vancomycin dosing regimen was based on the Practical Neonatology Medical Manual, published by the National Taiwan University College of Medicine. RESULTS: A total of 46 neonates were included for analysis. Coagulase-negative staphylococci were the most commonly identified pathogens of sepsis. Among these patients, 22 achieved goal trough levels of 10-20 mcg/mL. Trough levels of 5-10 or >20 mcg/mL occurred in 13 and 11 patients, respectively. A moderately positive correlation between trough and predicted AUC24 was found in all patients (Spearman's rho = 0.676, p < 0.001). In patients with body weight 1200-2000 g and postnatal age >7 days, the serum creatinine of those with trough levels >20 mcg/mL was significantly higher than those with goal trough levels (0.61 vs. 0.45 mg/dL, p = 0.01). Among those with trough levels >20 mcg/mL, 5 patients received ibuprofen for patent ductus arteriosus closing prior to vancomycin treatment (45%, 5/11), compared to only 3 patients with trough levels <20 mcg/mL (9%, 3/35) (p = 0.013). CONCLUSION: Only half of the neonates receiving empirical vancomycin regimen achieved goal trough levels of 10-20 mcg/mL. Higher serum creatinine or ibuprofen treatment may increase the risk of overly high trough levels. The vancomycin regimen needs further validation and modification to provide adequate dosing for optimal use in neonates.

The relationship between organizational climate, job stress, workplace burnout, and retention of pharmacists.

OBJECTIVES: This study explored the relationship between organizational climate, job stress, workplace burnout, and retention of pharmacists. This study adopted a cross-sectional design and conducted a questionnaire survey of pharmacists working at three teaching hospitals (a district teaching hospital, a regional teaching hospital, and a medical center). METHODS: The sampling criteria were a license to practice pharmacy and a willingness to sign a written consent form to participate in this study. RESULTS: One hundred ten questionnaires were distributed, of which 101 contained valid responses, yielding a valid return rate of 91.82%. A significant correlation was evident between organizational climate, job stress, workplace burnout, and retention. Hierarchical regression analysis revealed that demographic variables, organizational climate, job stress, and workplace burnout had a predictive power of 55.6% for retention (F = 9.712***, P < .001). Organizational climate had a significant positive correlated with retention (ß =  0.401*, P < .001). CONCLUSIONS: The results of this study can help hospitals to create a friendly and healthy workplace, instruct hospital managers how to improve their organizational climates, and reduce pharmacists' job stress and workplace burnout, thereby enhancing the quality of pharmacy service and medication safety and eventually improving pharmacists' intention to stay.

Applying HFMEA to prevent chemotherapy errors.

To evaluate risk and vulnerability in the chemotherapy process using a proactive risk analysis method. Healthcare failure mode and effect analysis (HFMEA) was adopted to identify potential chemotherapy process failures. A multidisciplinary team is formed to identify, evaluate, and prioritize potential failure modes based on a chemotherapy process flowchart. Subsequently, a decision tree is used to locate potential failure modes requiring urgent improvement. Finally, some recommended actions are generated and executed to eliminate possible risks. A total of 11 failure modes were identified with high hazard scores in both inpatient and outpatient processes. Computerized physician order entry was adopted to eliminate potential risks in chemotherapy processes. Chemotherapy prescription errors significantly decreased from 3.34% to 0.40%. Chemotherapy is regarded as a high-risk process. Multiple errors can occur during ordering, preparing, compounding, dispensing, and administering medications. Subsequently, these can lead to serious consequences. HFMEA is a useful tool to evaluate potential risk in healthcare processes.