Abstract: Objective To study the role of clinical pharmacists in serum vancomycin concentration monitoring, so as to provide references for rational use of drug service in clinical settings practice. Methods We collected the patients data with vancomycin concentration monitoring from 2011~2013. Based on the characteristics of these patients, we divided the samples into three groups: no-target group (concentration <10 μg·mL-1), target group (10~20 μg·mL-1), over-target group (>20 μg·mL-1). Results The proportion of dose increase in the no-target group was 3%(3/35).The ratio of no dose adjustment in target group was 91%(48/53), but the ratio of dose reduction in over-target group accounts for 12.5% (3/24). Conclusion There was no statistics difference in three group. The clinicians seem to adopt pharmacist intervention in target group. Clinical pharmacists should cooperate with clinicians to ensure effective medication usage.

Key words: vancomycin, intervention, clinical pharmacist