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Assessment of Antimicrobial Utilization Metrics: Days of Therapy Versus Defined Daily Doses and Pharmacy Dispensing Records Versus Nursing Administration Data

Published online by Cambridge University Press:  30 March 2015

Bruce R. Dalton ,
Deana M. Sabuda ,
Lauren C. Bresee  and
John M. Conly
Bruce R. Dalton*
Affiliation:
Pharmacy Department, Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
Deana M. Sabuda
Affiliation:
Pharmacy Department, Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
Lauren C. Bresee
Affiliation:
Pharmacy Department, Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
John M. Conly
Affiliation:
Institute for Public Health, University of Calgary, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Synder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
*
Address correspondence to Bruce R. Dalton, PharmD, Clinical Pharmacy Office, Rm 1080, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, Canada, T2N 2T9 (bruce.dalton@albertahealthservices.ca).
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Abstract

OBJECTIVE

To compare antimicrobial utilization data derived from pharmacy dispensing records and nursing administration record data by 2 commonly used units of measure.

DESIGN, PARTICIPANTS, AND METHODS

Data from nursing administration records and pharmacy dispensing records were obtained for 32 medical wards. From nursing and pharmacy data, defined daily doses (DDD) were calculated, and from the nursing data, days of therapy were derived. Direct comparison of total antimicrobial use was performed by graphical analysis and linear regression. Slope of trend line was used to quantify the difference between pairs of measures. Bland-Altman plots were constructed to determine constant and proportional bias. At the level of individual agents, difference between pairs of measures was calculated and presented graphically and the average (95% CI) for the difference between measures was determined.

RESULTS

Nursing administration record–derived DDD were on average 23% lower than corresponding rates of pharmacy dispensing record–derived DDD. The difference between rates of utilization by days of therapy vs DDD from the same source (nursing) was relatively small. Results from analysis of different individual agents were highly variable with wide 95% CIs.

CONCLUSIONS

In our setting, we found clinically relevant differences in antimicrobial utilization associated with data from different sources. This outweighed the importance of the metric (DDD or days of therapy). However, measurement of use of individual agents was highly variable and sensitive to both metric unit and data sources.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 6 , June 2015 , pp. 688 - 694
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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