Update: Vancomycin Troughs

After speaking with Jill (PharmD), and Donna Butler (redcoat) we realized that the proper method of ordering and drawing vancomycin troughs (or any drug levels) was never rolled out to our staff.  I've deleted my previous post so there is no confusion in the future.  Donna created a very detailed powerpoint with screenshots explaining step-by-step how we are supposed to order drug level labs and how we record exactly when we want the levels.  I have placed printed copies in both PICU and 7C break rooms.  Please refer to these when drug levels are ordered for your patient.  If your patient is on vancomycin, expect to be following this process.  It may seem confusing, but if you refer to the printed copy as you read this, it is pretty detailed and easy to follow.

The MD will enter an order for "Protocol: Therapeutic Drug Monitoring..." you will see this order under labs, but it WILL NOT print a slip.  The order will state to draw level "30 min before dose number __" for vanc troughs.  When the RN confirms that order, it is their responsibility to go into Meds Chart, click on the medication- in this case, Vancomycin, and the corresponding administration times will appear.  Click add comment to the dose the trough is ordered before.  Type "order and draw trough 30 min before administering this dose" in the comment box.  What this does is highlights that dose in blue to alert the nurse that they must draw the trough prior to that dose.  This is most helpful when med times get pushed back or changed for whatever reason.  We have had several PSNs for levels being drawn at incorrect times.

When you are ready to draw your level, you have to order it yourself just like we dispense blood products: go to Enter Orders --> written--> select MD who entered protocol-->type "thera" in the box and the therapeutic drug monitoring order form is the first item on the list.  Select it and the form will appear.  In the top left you select peak, trough or random and STAT so your slip prints immediately, enter the date and time of the last dose, then select Place Orders --> DONE --> Accept Orders and Exit.
This will print your lab slip within 2 minutes.  You can then send your level, then DC the order. 

I know this sounds like a lot of extra work, but if it is done correctly, one RN will be acknowledging the order and highlighting the correct dose, and the next RN will be entering the order for the lab slip.  So you should only be doing one or the other, not both for the same patient.   If you get an order for vancomycin, in particular, and you don't see the therapeutic drug monitoring protocol order, remind the resident to enter it.  This will save time and confusion when it comes time for the level to be drawn. 

I'm more than happy to go over this process with anyone, and Donna Butler offered to do some inservices if the powerpoint wasn't enough.  Let me know what you need- just wanted to get this out to you ASAP so we can start using this method.  Thanks Everyone!
-Erin