Gaps in Transition: Management of Intravenous Vancomycin Therapy in the Home and Community Settings

As a result of changes in healthcare delivery, patients are increasingly receiving medical treatment in the home and community setting, instead of as inpatients in a hospital. Patients receiving prolonged parenteral antibiotic therapy are among potential suitable candidates to continue treatment outside the hospital setting. However, outpatient management of these individuals, particularly those receiving antibiotics that require therapeutic drug and adverse effect monitoring (e.g., aminoglycosides, vancomycin) can pose serious safety concerns. As part of an ongoing collaboration with a provincial death investigation service, ISMP Canada received a report of the death of an individual who was being treated at home with parenteral vancomycin. This safety bulletin focuses on the potential for serious harm to patients, as well as the challenges faced by practitioners, when antimicrobial therapy requiring therapeutic drug monitoring (TDM) is delivered in the community at home.