Deriving measures of XXXX antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers.

@entity1 @entity1213
OBJECTIVE: To outline methods for deriving and validating @entity1213 ( @entity1213 ) antimicrobial utilization (AU) measures from computerized data and to describe programming problems that emerged. DESIGN: Retrospective evaluation of computerized pharmacy and administrative data. SETTING: ICUs from 4 academic medical centers over 36 months. INTERVENTIONS: Investigators separately developed and validated programming code to report AU measures in selected ICUs. Use of antibacterial and antifungal drugs for systemic administration was categorized and expressed as antimicrobial-days (each day that each antimicrobial drug was given to each @entity1 ) and @entity1 -days receiving antimicrobials (each day that any antimicrobial drug was given to each @entity1 ). Monthly rates were compiled and analyzed centrally, with @entity1213 @entity1 -days as the denominator. Results were validated against data collected from manual review of medical records. Frequent discussion among investigators aided identification and correction of programming problems. RESULTS: AU data were successfully programmed though a reiterative process of computer code revision. After identifying and resolving major programming errors, comparison of computerized @entity1 -level data with data collected by manual review of medical records revealed discrepancies in antimicrobial-days and @entity1 -days receiving antimicrobials that ranged from less than 1% to 17.7%. The hospital from which numerator data were derived from electronic records of medication administration had the least discrepant results. CONCLUSIONS: Computerized AU measures can be derived feasibly, but threats to validity must be sought out and corrected. The magnitude of discrepancies between computerized AU data and a gold standard based on manual review of medical records varies, with electronic records of medication administration providing maximal accuracy.
