Evaluation of a tool to benchmark hospital antibiotic prescribing in the United Kingdom.
OBJECTIVE
To investigate whether Defined Daily Dose/Finished Consultant Episode (DDD/FCE) ratio is sensitive to changes in prescribing patterns and could be used as a prescribing indicator in hospitals.


METHODS
The study comprised two phases. In phase 1 the weekly DDD/FCE ratios for two antibiotics were calculated and monitored in one acute NHS hospital before and after the implementation of prescribing guidelines, which impacted on the use of the antibiotics. In phase 2 data on the use of four antibiotics over one year was collected from fifty-eight medium to large acute hospitals in England, together with corresponding FCE data. DDD/FCE ratios for each antibiotic in each hospital were compared.


METHODS
Whether the DDD/FCE ratio for two antibiotics changed in one hospital following the introduction of prescribing guidelines for these antibiotics. The variability in DDD/FCE ratio for two broad spectrum antibiotics compared to two narrow spectrum antibiotics across a number of acute hospitals in England.


RESULTS
In phase 1 the DDD/FCE ratios for the two antibiotics were lower post implementation of the guidelines indicating that the ratio was sensitive to changes in prescribing. In phase 2 the median DDD/FCE ratios of the two broad spectrum antibiotics from all fifty eight hospitals were much higher (0.126, and 0.265) than for the two narrow spectrum antibiotics (0.048, and 0.021), indicating higher use of the broad spectrum antibiotics. Furthermore, the variation in prescribing between the hospitals, as indicated by the inter-quartile range about the median, was greater for the two broad spectrum agents (0.201 and 0.193), than for the narrow spectrum agents (0.06, and 0.042), as was expected.


CONCLUSIONS
The DDD/FCE ratio is sensitive to changes in prescribing and can reflect differences in the use of antibiotics between hospitals, after accounting for differences in activity. DDD/FCE ratio has the potential to be used to also account for differences in case mix between hospitals although further work is needed in this area.
Fitzpatrick
Raymond W
RW
Clinical Director of Pharmacy, Pharmacy Department, Royal Wolverhampton Hospitals, Wednesfield Road, Wolverhampton WV10 0QP, United Kingdom. ray.fitzpatrick@rwh-tr.nhs.uk
Edwards
Catherine M C
CM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019985:Benchmarking; D002444:Cefuroxime / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D015331:Cohort Studies; D003625:Data Collection; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012293:Rifampin / Q000627:therapeutic use; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002444:Cefuroxime; D007538:Isoniazid; D012293:Rifampin