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Round A, Clifton E, Stachow L, Mittal S, Yadav K, Ashraf H, Sanghera RS, Ng KF. Continuous infusion of vancomycin improved therapeutic levels in term and preterm infants. J Perinatol. 2021 Jan 19. doi: 10.1038/s41372-020-00909-3. Epub ahead of print. PMID: 33469164.

Background: Growing evidence suggests that continuous infusion of vancomycin (CIV) is superior to intermittent infusion of vancomycin (IIV) in neonates. This quality improvement (QI) project aimed to transition from IIV to CIV with earlier and improved attainment of therapeutic vancomycin levels.

Methods: The Model for Improvement framework with Plan Do Study Act cycles was used. Prospective data were collected during three phases: IIV, CIV-1 and CIV-2.

Interventions: A QI team developed a CIV drug monograph and a multidisciplinary education package.

Results: Using IIV, 36% (9/25) of first vancomycin levels were within target range. CIV achieved therapeutic levels twice as quickly as IIV (p < 0.05) with improved first vancomycin target levels (IIV 36%, 9/25; CIV-1 55%, 16/29; CIV-2 61%, 14/23) and total therapeutic levels (IIV 44%, 37/84; CIV-1 56%, 55/98; CIV-2 69%, 79/114).

Conclusions: This QI project demonstrated a successful transition from IIV to CIV with reduced time to achieve target vancomycin and an increased proportion of therapeutic levels.

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