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Team Recognized for Improving the Efficacy and Safety of Intravenous Vancomycin Therapy

Plymouth, Mass. – Beth Israel Deaconess Hospital–Plymouth (BID Plymouth) was recently recognized by the Massachusetts Society of Health System Pharmacists (MSHP) for advancements in patient safety enabled by precision dosing. For the third time in the past twelve years, BID Plymouth earned the state organization’s Health-System Pharmacy of the Year award, this time for improving the efficacy and safety of intravenous vancomycin therapy.

BID Plymouth’s ongoing, multidisciplinary program, implemented within the past two years, was recognized by the MSHP as a program that improves patient care quality, increases clinical competence, and contains costs. The program’s goal is to reduce overuse of vancomycin, one of the few remaining broad-spectrum antibiotics with the ability to treat life-threatening infections such as methicillin-resistant S. aureus (MRSA). Vancomycin’s overuse carries two risks; first, injudicious use of the antimicrobial could blunt its efficacy against MRSA, and second, treatment with it puts patients at elevated risk of acute kidney injury (AKI) which can lead to longer hospital stays and additional costs.

Led by BID Plymouth’s Antimicrobial Stewardship Committee, Co-Chaired by Stephanie Marglin, MD and James Berghelli, R.Ph., MS, the program also aims to take patients off the drug, or de-escalate, when appropriate. To that end the group, which includes a multidisciplinary team consisting of providers, pharmacists, microbiologists, nursing, and quality specialists, developed protocols that let pharmacists order preapproved MRSA surveillance nasal swabs when providers order vancomycin to treat patients with aspiration pneumonia.

During the first year of the program, 73 percent of tested patients were able to discontinue vancomycin due to negative MRSA nasal screenings. In addition, 68 percent of BID Plymouth’s patients achieved targeted therapeutic levels within one to two days, thanks to a clinical decision support tool that uses patient-specific data, pharmacokinetic/pharmacodynamic (PK/PD) models, and Bayesian forecasting to help clinicians determine and adjust each patient’s optimal dosing regimen. Since 2017, BID Plymouth’s pharmacists have monitored patients for kidney toxicity multiple times a day, seven days a week. As a result, the hospital has maintained an exceptionally low 3 percent rate of AKIs following 48 hours of vancomycin therapy, a figure which dropped to zero AKIs in Q2 2022.

“When the new vancomycin guidelines came out, we trialed the new recommended dose monitoring with our 14 ICU beds,” said Timothy Winders, PharmD, BCPS, Director of Pharmacy at BID Plymouth. “Instead of using spreadsheets to calculate the drug level, our pharmacists relied on specialized analytics for accurate predictions. Our aim is to standardize the quality of care we provide for the institution.”

“We’re delighted to be recognized by the Massachusetts Society of Health System Pharmacists for our work in this area,” said Berghelli, R.Ph., MS, director of clinical integration at BID Plymouth. “For the past decade, clinical pharmacists at BID Plymouth have assumed full responsibility for the hospital’s dosing of vancomycin. Our team works hard to ensure that vancomycin remains the viable and valuable resource that it is, not just for our patients who need it today, but for those who may need it down the road.”

About Beth Israel Deaconess Hospital–Plymouth

Beth Israel Deaconess Hospital–Plymouth (BID Plymouth) is a non-profit healthcare and hospice provider, serving 250,000 residents of 12 towns in Plymouth and Barnstable Counties. BID Plymouth is a full-service, 170-bed acute care community hospital accredited by The Joint Commission, the College of American Pathologists, the American College of Surgeons Commission on Cancer, and the American College of Radiology.

BID Plymouth is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,800 physicians and 36,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.

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