Ensuring the safety and efficacy of Gentamicin – Improvement guide now available

An innovative guide for improving the use of Gentamicin in acute hospital settings has been published under the National Quality Improvement Programme

Under the National Quality Improvement Programme, which is jointly led by RCPI and the HSE's Quality and Patient Safety Directorate, a multidisciplinary group has developed an innovative set of guidelines for hospitals seeking to ensure the safety and efficacy of a powerful but potentially toxic antibiotic.

Developed by frontline clinicians, support staff and national quality improvement experts, the guide is essentially an aid to direct hospitals through the process of improving the quality of prescribing and usage of Gentamicin. It covers all stages of the quality improvement journey:

    •    Establishing structure
    •    Establishing an aim
    •    How to start measuring
    •    How to start making changes

Gentamicin - Small difference between optimal and toxic dosing

Gentamicin is the seventh most commonly used antibiotic in Irish hospitals, given to approximately 15,000 patients per annum. It is a potentially life-saving drug, used to treat Gram-negative infection in amongst the sickest cohort of patients cared for in our hospitals. However Gentamicin has a narrow therapeutic index. This means that there is only a small difference between optimal and toxic dosing.

Failure to achieve optimal dosing can lead to increased patient morbidity and mortality, and increased resistance. Over-dosage can cause temporary or permanent kidney damage, loss of hearing or balance disturbance.

Download the Gentamicin Improvement Guide

Improvement Guide

Driver Diagram

Run Chart

SMART Aim Statement

Stakeholder Map

Better patient outcomes

By following the advice in this improvement guide, hospitals may see the following benefits

    •    Better patient outcomes in treating Gram negative sepsis, including potentially reduced mortality
    •    Reduced need to escalate to broader spectrum antibiotics, thereby preserving their utility for more complex infective cases
    •    Reduced time spent in hospital due to sub-therapeutic use of Gentamicin
    •    Reduced rates of harm from inappropriate use
    •    Fewer patients requiring Nephrology or Critical Care referral
    •    Potentially reduced costs associated with harm from Gentamicin, including reduced direct treatment costs, renal replacement therapy costs and litigation costs
    •    Potentially reduced length of stay for patients treated with Gram-negative sepsis

It should be noted that this guide relies on appropriate patient selection. Careful consideration of the potential risks and benefits should occur for every patient. This risk assessment should continue throughout therapy.

Quarterly check-in meetings to discuss progress

Anyone using this guide is invited to attend or dial into quarterly quality meetings at which others using it discuss their progress and seek advice on improvement.

The next meeting is on Tuesday 8 September 2015 at 16:00. Please contact Vicky Taylor to confirm your attendance: victoriataylor@rcpi.ie

About the National Quality Improvement Programme

The National Quality Improvement Programme aims to improve healthcare in Ireland by giving participants the understanding and tools they need to carry out improvement projects.

This programme has been jointly led by RCPI and the Quality and Patient Safety Directorate and funded and supported by the Quality and Patient Safety Directorate under the direction of Dr. Philip Crowley.

Related Links

Gentamicin Improvement Project

About the National Quality Improvement Programme