Hostname: page-component-77c89778f8-vpsfw Total loading time: 0 Render date: 2024-07-17T14:49:46.208Z Has data issue: false hasContentIssue false

Antimicrobial Consumption Data From Pharmacy and Nursing Records: How Good Are They?

Published online by Cambridge University Press:  21 June 2016

Gail S. Itokazu*
Affiliation:
John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
Robert C. Glowacki
Affiliation:
John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
David N. Schwartz
Affiliation:
John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois Rush Medical College, Chicago, Illinois
Mary F. Wisniewski
Affiliation:
John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
Robert J. Rydman
Affiliation:
John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois University of Illinois at Chicago School of Public Health, Chicago, Illinois
Robert A. Weinstein
Affiliation:
John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois Rush Medical College, Chicago, Illinois
*
John H. Stroger Jr. Hospital of Cook County, Division of Infectious Diseases, 637 S. Wood St., Durand Building – Room 110, Chicago, IL 60612gitokazu@uic.edu

Abstract

Objective:

To determine whether randomly selected intravenous (IV) antimicrobial doses dispensed from an inpatient pharmacy were administered.

Design:

This was a prospective, cross-sectional study in which dose administration was confirmed by direct observation and by assessment of the medication administration record (MAR). A retrospective analysis of the return rate of unused IV antimicrobial doses was performed subsequently.

Setting:

Medical and surgical intensive care units (ICUs) and non-ICUs of a 550-bed urban public teaching hospital.

Participants:

Hospitalized patients with an order in the pharmacy database for an IV antimicrobial during 9 non-consecutive weekdays in June 1999.

Results:

Of 397 doses, 221 (55.7%) assessed by bedside observation and 238 (59.9%) assessed by MAR review were classified as administered; 139 doses (35.0%) were dispensed but changes in the drug order or the patient's status prevented their administration. In the subsequent assessment, of 745 IV antimicrobial doses dispensed during 24 hours, 322 (43.2%) were returned to the pharmacy unused; 423 (56.8%) of the doses—consistent with our prior observations—were presumably administered.

Conclusions:

Because computerized pharmacy data may overestimate actual antimicrobial consumption, such data should be validated when used in studies of hospital antimicrobial use. Dispense-return analysis offers a simple validation method.

Type
Orginal Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McGowan, JE, Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130:165168.Google Scholar
2.Jewesson, PJ, Ho, R, Jang, Q, Watts, G, Chow, AW. Auditing antibiotic use in a teaching hospital: focus on cefoxitin. Canadian Medical Association Journal 1983;128:10751078.Google Scholar
3.Morris, JG, Shay, DK, Hebden, JN, et al.Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250259.Google Scholar
4.Quale, J, Landman, D, Saurina, G, Atwood, E, DiTorre, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:10201025.Google Scholar
5.Frank, MO, Batteiger, BE, Sorensen, SJ, et al.Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clinical Performance and Quality Health Care 1997;5:180188.Google Scholar
6.Toltzis, P, Yamashita, T, Vilt, L, et al.Antibiotic restriction does not alter endemic colonization with resistant gram-negative rods in a pediatric intensive care unit. Crit Care Med 1998;26:18931899.Google Scholar
7.Shojania, KG, Yokoe, D, Piatt, R, Fiskio, J, Ma'luf, N, Bates, DW. Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J Am Med Inform Assoc 1998;5:554562.Google Scholar
8.Carling, PC, Fung, T, Coldiron, JS. Parental antibiotic use in acute-care hospitals: a standardized analysis of fourteen institutions. Clin Infect Dis 1999;29:11891196.Google Scholar
9.López-Lozano, J-M, Monnet, DL, Yague, A, et al.Modeling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000;14:2131.Google Scholar
10.Patterson, JE, Hardin, TC, Kelly, CA, Garcia, RC, Jorgensen, JH. Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2000;21:455458.CrossRefGoogle ScholarPubMed
11.Leverstein-van Hall, MA, Fluit, AC, Blok, HEM, et al.Control of nosocomial multiresistant Enterobacteriaceae using a temporary restrictive antibiotic agent policy. Eur J Clin Microbiol Infect Dis 2001;20:785791.Google Scholar
12.Recco, RA, Gladstone, JL, Friedman, SA, Gerken, EH. Antibiotic control in a municipal hospital. JAMA 1979;241:22832286.Google Scholar
13.Seligman, SJ. Reduction in antibiotic costs by restricting use of an oral cephalosporin. Am J Med 1981;71:941944.Google Scholar
14.Woodward, RS, Medoff, G, Smith, MD, Gray, JL. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. Am J Med 1987;83:817823.Google Scholar
15.Hirschman, SZ, Meyers, BR, Bradbury, KMehl, B, Gendelman, S, Kimelblatt, B. Use of antimicrobial agents in a university teaching hospital: evolution of a comprehensive control plan. Arch Intern Med 1988;148:20012007.Google Scholar
16.Kuyumjian, AG, Levine, JF, Gross, PA, Lo Presti, A. A prospective study of antibiotic cost containment in a university teaching hospital over a 13-year period. Pharmacy and Therapeutics 2002;11:565568.Google Scholar
17.Ballow, CH, Schentag, JJ. Trends in antibiotic utilization and bacterial resistance: report of the National Nosocomial Resistance Surveillance group. Diagn Microbiol Infect Dis 1992;15(suppl):37S42S.Google Scholar
18.Leseti, CA, Itokazu, GS, Danziger, LH, Weinstein, RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis 2001;41:149154.Google Scholar
19.Ridley, M, Barrie, D, Lynn, R, Stead, KC. Antibiotic-resistant Staphylococcus aureus and hospital antibiotic policies. Lancet 1970;1:230233.Google Scholar
20.Palleres, R, Dick, R, Wenzel, RP, Adams, JR, Nettleman, MD. Trends in antimicrobial utilization at a tertiary teaching hospital during a 15-year period (1978-1992). Infect Control Hosp Epidemiol 1998;14:376382.Google Scholar
21.White, AC, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230239.Google Scholar
22.Rahal, JJ, Urban, C, Horn, D, et al.Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998;280:12331237.Google Scholar
23.Monnet, DL, Archibald, LKPhillips, L, Tenover, FC, McGowan, JE, Gaynes, RP. Antimicrobial use and resistance in eight US hospitals: complexities of analysis and modeling. Infect Control Hosp Epidemiol 1998;19:388394.Google Scholar
24.Montecalvo, MA, Jarvis, WR, Uman, J, et al.Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med 1999;131:269272.Google Scholar
25.Fridkin, SK, Edwards, JR, Courval, JM, et al.The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units. Ann Intern Med 2001;135:175183.Google Scholar
26.Lautenbach, E, LaRosa, LA, Marr, AM, Nachamkin, I, Bilder, WB, Fishman, NO. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions: impact of progressive restrictions on use of vancomycin and third-generation cephalosporins. Clin Infect Dis 2003;36:440446.CrossRefGoogle ScholarPubMed
27.Solomon, DH, Van Houten, L, Glynn, RJ, et al.Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Arch Intern Med 2001;161:18971902.Google Scholar
28.Lepper, PM, Grusa, E, Heichl, H, Hogel, J, Trautmann, M. Consumption of imipenem correlates with β-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother 2002;46:29202925.Google Scholar
29.Salberg, DJ, Newton, RW, Leduc, DT. Cost of wastage in a hospital intravenous admixture program. Hospital Formulary 1984;19:375378.Google Scholar
30.Boomer, G, Savoy, LB, Marten, R. The effect of oral communication on intravenous wastage: talk is cheap. Hospital Pharmacy 1993;28:404-405, 407409.Google Scholar
31.Davis, NM. Minimizing waste of prepared sterile products. Hospital Pharmacy 1985;20:109,111114.Google Scholar
32.Coppola, PA, Cassidy, AP. Reducing waste: a significant cost containment measure in an IV additive program. Hospital Pharmacy 1987;22:1215-1216, 1246.Google Scholar
33.Diehl, LD, Goo, EDH, Sumiye, L, Ferrell, R. Reducing waste of intravenous solutions. American Journal of Hospital Pharmacy 1992;49:106108.Google Scholar
34.Tullio, CJ. Minimizing IV admixture waste in a 70-bed hospital. Hospital Pharmacy 1987;22:994, 997, 1001.Google Scholar
35.Wirtz, V, Taxis, K, Barber, ND. An observational study of intravenous medication errors in the United Kingdom and in Germany. Pharm World Sci 2003;25:104111.Google Scholar
36.Fontan, JE, Maneglier, V, Nguyen, VX, Loirat, C, Brion, F. Medication errors in hospitals: computerized unit dose drug dispensing system versus ward stock distribution system. Pharm World Sci 2003;25:112117.Google Scholar
37.Barker, KN, McConnell, WE. The problems of detecting errors in hospitals. American Journal of Hospital Pharmacy 1962;19:361369.Google Scholar
38.Schiff, GD, Rucker, TD. Computerized prescribing: building the electronic infrastructure for better medication usage. JAMA 1998:279:10241029.Google Scholar
39.Hoolihan, RJ, Erickson, BA. Strategies for reducing IV drug waste and coping with increased workload. Hospital Pharmacy 1987;22:871876.Google Scholar
40.Hogan, WR, Wagner, MM. Accuracy of data in computer-based patient records. J Am Med Inform Assoc 1997;5:342355.Google Scholar
41.Katz, E. Unadministered medications in a unit dose system. Quality Review Bulletin 1980;6:2024.Google Scholar
42.Veltri, GM, Stile, IL, Coleman, JB, Vittorini, MA. Charting accuracy of scheduled medications in the medication administration record. Hospital Pharmacy 1986;21:11411143.Google Scholar