Prior to discharge on outpatient IV vancomycin therapy, the healthcare team should:
Review:
The treatment plan to confirm that oral alternatives are not available or appropriate for patient management
The feasibility and safety of the treatment and care plan
The patient’s concomitant medications to identify any nephrotoxic agents (e.g. aminoglycoside, NSAID, diuretic, ACEI, ARB, etc.) and evaluate whether any should be held for the duration of treatment
Communicate:
The treatment and care plan to the patient and/or care givers and community healthcare providers; including necessary blood work, target levels and duration of therapy
The importance of proper timing of blood work in relation to administration of the vancomycin dose to allow interpretation of vancomycin serum concentrations
Additionally:
Educate and inform the patient and their caregivers on the signs and symptoms of potential adverse reactions to report or act on
Arrange all necessary monitoring test and follow-up appointments
Avoid scheduling blood work on Fridays because interpretation may be delayed