Vancomycin AUC-Dosing Initiative at a Regional Antibiotic Stewardship Collaborative

Background: Antibiotic stewardship programs (ASPs) are multidisciplinary teams that optimize anti-infective use across health systems. The Veterans Health Administration mandates all facilities to implement ASPs and requires the development of ASP collaboratives in its regional Veterans Integrated Service Networks (VISNs).

Observations: The Veterans Affairs Sunshine Healthcare Network (VISN 8) serves > 1.5 million veterans across Florida, South Georgia, Puerto Rico, and the US Virgin Islands. Established in 2015, the VISN 8 ASP workgroup, serves as a model for ASP VISN collaboratives and includes ASP champions from each Veterans Affairs medical center within VISN 8 and meets monthly to review formulary issues, ongoing initiatives, antimicrobial use metrics, and other related topics. The VISN collaborative structure facilitates multisite quality initiatives, such as the implementation of area under the curve (AUC)-guided vancomycin dosing across 4 health care systems within VISN 8. AUC-guided dosing led to decreased rates of acute kidney injury compared with trough-based dosing (2.4% vs 10.4%) and the quality assurance evaluation identified best practices that could be disseminated across the VISN.

Conclusions: The VISN 8 ASP workgroup exemplifies how ASP champions can work together to solve common issues, complete tasks more efficiently, and impact large veteran populations. ASP collaboratives can leverage their collective size to complete robust multisite quality assurance evaluations. Expansion of the ASP collaborative model further highlights the Veterans Health Administration as a nationwide leader in ASP best practices.