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Improving dosing of gentamicin in the obese patient: a 3-cycle drug chart and case note audit.

Manjaly JG, Reece-Smith AM, Sivaloganathan SS, Thuraisamy C, Smallwood KL, Jonas E, Longman RJ - JRSM Short Rep (2012)

Bottom Line: University Hospitals Bristol, UK PARTICIPANTS: Patients receiving once daily intravenous gentamicin using the trust protocol, during the same time window for 3 consecutive years. i) Accuracy of dose and frequency prescription of Gentamicin. ii) Time frame for measurement of serum Gentamicin levels.Errors in frequency calculations dropped from 12.8% to 4%.Serum gentamicin levels can be measured within a 2.5 hour time frame in the environment of an NHS hospital.

View Article: PubMed Central - PubMed

Affiliation: CST1 , Salisbury NHS Foundation Trust , Salisbury , UK.

ABSTRACT

Objectives: To assess the use of an electronic dose calculator to improve accuracy in the use of a complex Gentamicin prescription policy and assess turnaround time of blood sampling to dose delivery in an NHS hospital.

Design: Retrospective review of drug chart, case notes and hospital antibiotic database.

Setting: University Hospitals Bristol, UK PARTICIPANTS: Patients receiving once daily intravenous gentamicin using the trust protocol, during the same time window for 3 consecutive years.

Main outcome measures: i) Accuracy of dose and frequency prescription of Gentamicin. ii) Time frame for measurement of serum Gentamicin levels.

Results: Following the introduction of the online calculator, prescribing errors in obese patients dropped from 43% to 20%, a similar level as in non-obese patients. Errors in frequency calculations dropped from 12.8% to 4%. On average, drug doses could be administered within 2.5 hours of a blood sample being taken.

Conclusions: Online tools can be used to improve prescribing for the complex dosing policies that will increasingly been required to tailor prescribing in obese patients. Serum gentamicin levels can be measured within a 2.5 hour time frame in the environment of an NHS hospital.

No MeSH data available.


Related in: MedlinePlus

% of patients with an incorrectly calculated frequency according to protocol
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SHORTS-11-131F2: % of patients with an incorrectly calculated frequency according to protocol

Mentions: According to the protocol, frequency of prescription can vary every dose as renal function varies. As such, the total number of prescriptions are reported rather than the number of patients with all frequencies correct. The accuracy of frequency prescription was difficult to assess due to occasional delays between prescription and dosing. Although the prescription recorded the planned time of the next dose and the time the previous dose was given, the time of the prescription was not always recorded and may differ from the dosing time. As such, up to 65% of frequency prescriptions could not be accurately assessed, although cases in which errors were present were easier to identify, primarily because most changes require extending the period between doses, leaving doses occurring early in spite of any delays occurring on the ward. In the first cycle 13 of 107 (12.2%) of prescriptions were at the incorrect frequency, 9 of which errors were in obese patients; in the second cycle this was 4 of 106 (3.8%) with 3 in obese patients; and 3 of 75 (4%) in the third cycle, 2 of which were obese. These results were significantly different between the 3 cycles (Pearson χ2 P = 0.017). (Figure 2)


Improving dosing of gentamicin in the obese patient: a 3-cycle drug chart and case note audit.

Manjaly JG, Reece-Smith AM, Sivaloganathan SS, Thuraisamy C, Smallwood KL, Jonas E, Longman RJ - JRSM Short Rep (2012)

% of patients with an incorrectly calculated frequency according to protocol
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3375840&req=5

SHORTS-11-131F2: % of patients with an incorrectly calculated frequency according to protocol
Mentions: According to the protocol, frequency of prescription can vary every dose as renal function varies. As such, the total number of prescriptions are reported rather than the number of patients with all frequencies correct. The accuracy of frequency prescription was difficult to assess due to occasional delays between prescription and dosing. Although the prescription recorded the planned time of the next dose and the time the previous dose was given, the time of the prescription was not always recorded and may differ from the dosing time. As such, up to 65% of frequency prescriptions could not be accurately assessed, although cases in which errors were present were easier to identify, primarily because most changes require extending the period between doses, leaving doses occurring early in spite of any delays occurring on the ward. In the first cycle 13 of 107 (12.2%) of prescriptions were at the incorrect frequency, 9 of which errors were in obese patients; in the second cycle this was 4 of 106 (3.8%) with 3 in obese patients; and 3 of 75 (4%) in the third cycle, 2 of which were obese. These results were significantly different between the 3 cycles (Pearson χ2 P = 0.017). (Figure 2)

Bottom Line: University Hospitals Bristol, UK PARTICIPANTS: Patients receiving once daily intravenous gentamicin using the trust protocol, during the same time window for 3 consecutive years. i) Accuracy of dose and frequency prescription of Gentamicin. ii) Time frame for measurement of serum Gentamicin levels.Errors in frequency calculations dropped from 12.8% to 4%.Serum gentamicin levels can be measured within a 2.5 hour time frame in the environment of an NHS hospital.

View Article: PubMed Central - PubMed

Affiliation: CST1 , Salisbury NHS Foundation Trust , Salisbury , UK.

ABSTRACT

Objectives: To assess the use of an electronic dose calculator to improve accuracy in the use of a complex Gentamicin prescription policy and assess turnaround time of blood sampling to dose delivery in an NHS hospital.

Design: Retrospective review of drug chart, case notes and hospital antibiotic database.

Setting: University Hospitals Bristol, UK PARTICIPANTS: Patients receiving once daily intravenous gentamicin using the trust protocol, during the same time window for 3 consecutive years.

Main outcome measures: i) Accuracy of dose and frequency prescription of Gentamicin. ii) Time frame for measurement of serum Gentamicin levels.

Results: Following the introduction of the online calculator, prescribing errors in obese patients dropped from 43% to 20%, a similar level as in non-obese patients. Errors in frequency calculations dropped from 12.8% to 4%. On average, drug doses could be administered within 2.5 hours of a blood sample being taken.

Conclusions: Online tools can be used to improve prescribing for the complex dosing policies that will increasingly been required to tailor prescribing in obese patients. Serum gentamicin levels can be measured within a 2.5 hour time frame in the environment of an NHS hospital.

No MeSH data available.


Related in: MedlinePlus