An evaluation of vancomycin drug level monitoring at University of Iowa Hospitals and Clinics indicates that although vancomycin drug levels are ordered as troughs, and subsequently resulted in Epic as a trough, the draw times are often not at appropriate timing to be considered a vancomycin drug level trough concentration. This sequence of events has resulted in inappropriate changes in vancomycin dosing for patients at UI Hospitals and Clinics. In an effort to improve the process for vancomycin drug level monitoring at UI Hospitals and Clinics, the following changes have been implemented.

• Vancomycin drug level ordering has been updated so that timed is the only frequency available.
• Nursing will release the vancomycin drug level order prior to the draw from the RN All Orders report and draw the levels in relation to the vancomycin administration.
• Vancomycin drug levels will no longer be labeled as '"trough", "random", or "peak". All vancomycin drug levels should be compared to the patient’s last dose of vancomycin to determine how long after the dose the vancomycin drug level was drawn.

Questions should be directed to Matthew Krasowski, MD, PhD, Medical Director of the Clinical Chemistry
(384-9380, matthew-krasowski@uiowa.edu).