Utilization of prospective, pharmacist-driven restriction criteria to improve appropriateness of empiric intravenous vancomycin use.

Objective: This objective of this study is to evaluate the impact of a prospective, pharmacist-driven restriction protocol on the appropriateness of IV vancomycin use in a community hospital setting. Methods: This single-health system, multi-site, quasi-experimental study compared pre-intervention (January-March 2024) and post-intervention (January-March 2025) groups. The intervention was a mandatory pharmacist-driven protocol requiring review of every empiric vancomycin order against pre-defined, evidence-based criteria. Inappropriate orders were proactively discontinued, and providers were notified with supporting rationale. The primary outcome was the percentage of appropriate empiric vancomycin orders, assessed by chart review of 100 random patients per group. Key secondary outcomes included vancomycin days of therapy per 1,000 patient days and trough levels ordered per 1,000 patient days. Results: Analysis of 200 patients (100 per group) showed that the appropriateness of empiric IV vancomycin orders significantly increased from 55% pre-intervention to 97% post-intervention (P < .001). Days of therapy per 1,000 patient days decreased from 69.3 to 64.2 (P < .041), and vancomycin trough levels ordered per 1,000 patient days decreased by 41% (52.3 vs. 31.1, P < .001). Crucially, no significant differences were observed in 30-day mortality, suggesting the improvements were achieved without compromising patient safety in patients who received vancomycin. Conclusions: Implementation of a prospective, pharmacist-driven empiric IV vancomycin restriction protocol offers a practical, effective strategy for institutions seeking to increase appropriateness of empiric IV vancomycin orders.