A Quality Improvement Project to Increase Pharmacist-Initiated Methicillin Resistant Staphylococcus Aureus Nasal Swab PCR for Vancomycin De-Escalation in Pediatric Patients With Respiratory Tract Infections

Document Type

Article

Publication Title

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG

Abstract

OBJECTIVE: Overuse of broad-spectrum empiric antimicrobials remains common in children hospitalized with respiratory tract infections (RTI). A negative methicillin-resistant

METHODS: Baseline duration of vancomycin therapy was assessed by conducting a retrospective chart review. After root cause analysis and engaging key stakeholders, an electronic health record OurPractice Advisory (OPA) was implemented, prompting pharmacists to order an MNS PCR during order verification for vancomycin with an RTI indication.

RESULTS: Preimplementation (01/01/2021 to 08/31/2023) included 89 patients, and 25 postimplementation (09/21/2023 to 05/31/2024). We found a 36% decrease in mean vancomycin duration from 53 to 34 hours after implementation of the pharmacist-driven OPA. Postimplementation, 24% of patients had a vancomycin concentration obtained, compared with 37% preimplementation. No patients were readmitted within 30 days postimplementation, compared with 1 patient preimplementation.

CONCLUSIONS: This QI initiative provides preliminary data that empiric vancomycin duration in pediatric patients with RTI may be impacted by pharmacist-facing OPA implementation, prompting ordering of MNS PCR at the time of vancomycin verification. This initiative could be replicated at other institutions seeking to reduce empiric vancomycin usage.

First Page

413

Last Page

418

DOI

10.5863/JPPT-25-00080

Publication Date

6-1-2026

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