IMPLEMENTATION OF A GENTAMICIN PRESCRIBING PLAN IN A SECONDARY CENTRE

Introduction

• Gentamicin is a common inpatient antibiotic with a narrow therapeutic window.

• Achieving safe gentamicin levels requires accurate, individualised prescribing adjusted for weight, height and renal function.

• This drug is commonly incorrectly prescribed with previous studies showing an error rate of 70% within our trust. Incorrect prescriptions leads to increased risks of toxicity and renal failure.

• A gentamicin dose calculator therefore could help reduce errors in gentamicin dosing, improving patient safety.

PLAN: AIMS

DO: METHODOLOGY

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• Assess if a mandatory Gentamicin Prescribing plan with integrated dose calculator and peer education improves gentamicin prescribing.

STUDY: RESULTS AND DISCUSSION

1. Correct gentamicin doses (adjusted to weight and height) prescribed in 77% of patients after implementation of the prescribing plan compared to 30% previously.

2. Adjusted body weight used in all patients ≥20% IBW and 5% increase in up-to-date weight documentation.

3. 98% of levels were taken one hour pre-next dose if poor renal function compared to 92% previously.

Ø The Gentamicin calculator has therefore, improved prescribing accuracy.

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• 472 prescriptions analysed between 04/01/21 to 23/02/21 prior to calculator implementation against the following quality standards:

Ø Correct dose prescribed.

Ø Up-to-date weight and adjusted body weight in patients ≥20% ideal body weight (IBW).

Ø Gentamicin levels measured 20-24hrs post first dose and one hour pre-dose if reduced eGFR (<60).

• Implementation of mandatory electronic prescribing plan with integrated dose calculator.

• Peer-peer education about the gentamicin care plan at departmental meetings.

• 241 adult prescriptions between 01/10/2101/12/21 analysed after interventions.

ACT: ADAPTATIONS FOR NEXT CYCLE

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• Increased up-to-date patient height/weight documentation.

• Pull-through of gentamicin calculator dose onto electronic prescription charts automatically to reduce chance of error.

• Improved accuracy of gentamicin levels monitoring by increasing education, including nursing staff, on when to take levels for each individual patient.

Learning Points

• Small changes can result in significant improvements to accurate prescribing

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• Multidisciplinary team education is key to maintaining changes implemented –increase education to include other MDT members

• Prescribing care plans can help reduce human error and maintain patient safety.