Obtaining and tracking data is essential in establishing an effective ASP.
Antibiotic Use Data
- Days of therapy (DOT) per 1,000 patient days or 1,000 days present
- Overall and for specific agents or groups of agents. DOT includes the cumulative days of therapy of each antibiotic. For example, if a patient received vancomycin and cefepime for 2 days, the DOT would be 4 (2 drugs x 2 days).
- Length of therapy (LOT) per 1,000 patient days or 1,000 days present
- Overall and for specific agents or groups of agents. LOT includes the total duration of therapy of any antibiotic therapy. For example, if a patient received vancomycin and cefepime for 2 days, the LOT would be 2.
- Denominator — patient days versus days present
- Patient days are determined based on hospital census data captured each day at a specific time. Therefore, if you have a patient in the hospital Monday through Wednesday and the daily census is captured at midnight the number of patient days would be 2. If the patient received an antibiotic on all 3 days then the DOT would be 3.
- Days present accounts for any time that the patient is present in the hospital. This data can be obtained from electronic health records through their admission, discharge and transfer data. Therefore, if a patient is in the hospital Monday through Wednesday, the days present is 3.
- Moehring 2018 Denominator Matters in Estimating Antimicrobial Use
- The Standardized Antibiotic Administration Ratios (SAARs) encompass observed-to-predicted antibacterial use for one of 47 antimicrobial agent-patient care location combinations.
- Outlier SAAR values may suggest possible overuse, underuse, or inappropriate use of Antibiotics.
- CDC provides this metric through the National Healthcare Safety Network’s Antimicrobial Use and Resistance (AUR) Module.
- Proportion of patients compliant with institutional guideline/treatment algorithm
- Proportion of patients converted to oral therapy
- Type of recommendations made by the ASP
- Acceptance rate of the recommendations
- Proportion compliant with Choosing Wisely Campaign recommendations
- Length of stay
- Antibiotic resistance, focusing on hospital-onset infections and impact on local antibiogram sensitivity patterns over time
- Adverse drug reactions (rates)
- Hospital-onset C. difficile infection rates
- Hospital Readmissions for select infections (SSTI, pneumonia, pyelonephritis)
- Antibiotic costs