A question came up yesterday. At my facilty you get the trough right before the vanco dose, then start up the vanco dose. The peak was due to be drawn 1/2 hour after the dose was in. The doc had ordered it done on the 2200 dose. One nurse challanged me because I didn't hold the vanco until after the trough came back. He's worked elsewhere, I work with him in ICU, but this was a Med-Surg pt that I was handing over after 4 hours, after having floated. Anyways he said that he always waits to start the vanco until after the trough is back, that it was protocol where he worked before. I discussed it with other co-workers and traditionally where I work we start up the vanco immediately, leaving the trough and peak for pharmacy and the doc to evaluate. I discussed it in the morning with yet another co-worker and we all agreed that perhaps we need clarification on this. What is the policy where you work? Any opinions? We are going to bring up this question with pharmacy and our manager.