Quality and cost improvement in neonatal prescribing through clinical audit

Gentamicin is one of the most frequently used antibiotics in neonatal units and there are many regimes in use based on weight andor gestational age GA. Direct costs include prescription and therapeutic drug monitoring TDM. A retrospective audit loop 1 identified 48 per cent trough and 51 per cent peak levels outside the desirable range trough 2 peak 510mgL. A prospective reaudit loop 2 showed improved results 15 per cent and 29 per cent, which improved further 11 per cent and 26 per cent in loop 3. For loops 1, 2, and 3 the mean SD trough levels were 2.16 1.04, 1.30 0.63 and 1.23 0.62 respectively and peak levels were 5.05 1.87, 6.64 2.48, and 6.2 1.81 respectively. Cost savings occurred as the number of doses required was reduced by onethird to 50 per cent, depending upon the infant characteristics. Furthermore, in 27 per cent of cases, gentamicin was discontinued before TDM was necessary. By completing the audit cycle improved quality of therapeutic care has been achieved, with more accurate drug monitoring targets achieved and reduced drug costs.