Scared

When was the next dose of Vanco due and when did you remember? I would have called the hospital right away just in case. Everyone forgets things...but don't ignore it.

I may be all wet, because I work in ER and this is not something we generally deal with, but where is the doctors responsibility in this? I have always worked where the pharmacy doses Vanco based on peaks/troughs and since it is given Q24 hours, there is plenty of time to do that. I would not think it would be entirely up to you to call, but then again, I have been wrong before!

I actually give Vanc bid more often than qd lately.

But regarding the OP:

First of all, five bucks says the doc already knows.

Second, I've never understood why anyone doses based on random levels. It's retarded. Use the peak and trough. At a level of 39, I'm betting good money you're drawing that lab pretty soon after giving the Vanc. Or he's getting like 2g IV q12h. 39 on a random level is pretty high to be truly "random".

Third, if you're dosing based on levels (especially if the pt's creatinine is swinging relatively large amounts in a short period of time), there should either be (1) a protocol to adjust the dosage based on the level, or (2) the med should only be written x1 for each day, then rewritten based on the lab.

Finally, at the risk of sounding obvious, a creatinine of 0.63 is extremely normal, which makes me wonder why you have to go through all this in the first place. Remember, the patient will never have a fever if you don't check the temperature.