Facilitators and Barriers to Antibiotic Stewardship: A Qualitative Study of Pharmacists’ Perspectives

Appaneal, Haley J; Luther, Megan K.; Timbrook, Tristan T; LaPlante, Kerry L.; Dosa, David

doi:10.1177/0018578718781916

Cited by 18 publications

(29 citation statements)

References 17 publications

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“…Time constraints were also reported by Weier and colleagues [43], in a cross-sectional survey of Australian and French hospital pharmacists (n = 259). Similarly, the need for protected time for stewardship within a supportive organisational culture was highlighted in a small qualitative study of pharmacists in the USA's Veterans Affairs centres [44]. The potential for the wider clinical pharmacist workforce to engage more directly with prescribers than is possible for the specialist AMT pharmacist may be worthy of further consideration.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

Currie

Laidlaw

Ness

et al. 2020

Antimicrob Resist Infect Control

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Background: Antimicrobial stewardship (AMS) describes activities concerned with safeguarding antibiotics for the future, reducing drivers for the major global public health threat of antimicrobial resistance (AMR), whereby antibiotics are less effective in preventing and treating infections. Appropriate antibiotic prescribing is central to AMS. Whilst previous studies have explored the effectiveness of specific AMS interventions, largely from uniprofessional perspectives, our literature search could not find any existing evidence evaluating the processes of implementing an integrated national AMS programme from multi-professional perspectives. Methods: This study sought to explain mechanisms affecting the implementation of a national antimicrobial stewardship programme, from multi-professional perspectives. Data collection involved in-depth qualitative telephone interviews with 27 implementation lead clinicians from 14/15 Scottish Health Boards and 15 focus groups with doctors, nurses and clinical pharmacists (n = 72) from five Health Boards, purposively selected for reported prescribing variation. Data was first thematically analysed, barriers and enablers were then categorised, and Normalisation Process Theory (NPT) was used as an interpretive lens to explain mechanisms affecting the implementation process. Analysis addressed the NPT questions 'which group of actors have which problems, in which domains, and what sort of problems impact on the normalisation of AMS into everyday hospital practice'. Results: Results indicated that major barriers relate to organisational context and resource availability. AMS had coherence for implementation leads and prescribing doctors; less so for consultants and nurses who may not access training. Conflicting priorities made obtaining buy-in from some consultants difficult; limited role perceptions meant few nurses or clinical pharmacists engaged with AMS. Collective individual and team action to implement AMS could be constrained by lack of medical continuity and hierarchical relationships. Reflexive monitoring based on audit results was limited by the capacity of AMS Leads to provide direct feedback to practitioners.

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Section: Discussionmentioning

confidence: 99%

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

Currie

Laidlaw

Ness

et al. 2020

Antimicrob Resist Infect Control

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“…Clearly defining and dedicating resources to the ASP is necessary for success [29,30]. The importance of pharmacy involvement in ASPs as well as assistance with antimicrobial optimization at the patient level has been well described [30,33,37,31]. Key facilitators of success for our institution's ASP initiatives as well as those from the literature has informed a larger scale restriction intervention.…”

Section: Plos Onementioning

confidence: 99%

“…Other institutions have also identified organization barriers to successful ASP initiatives. Specifically, a lack of allocated time and resources limits the impact of the ASP [33,34,36,37] and buy-in from leadership is necessary for success [37]. Hierarchy within the medical team, particularly relevant in academic medical centers, can also be a barrier to success.…”

Section: Plos Onementioning

confidence: 99%

Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: A mixed-methods study

Tischendorf

Brunner²,

Knobloch³

et al. 2020

PLoS ONE

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We conducted a quality improvement initiative to restrict fluoroquinolone prescribing on two inpatient units housing high-risk patients and applied a human factors approach to understanding the barriers and facilitators to success of this intervention by front-line providers. Methods This was a mixed-methods, quasi-experimental study. This study was conducted on two inpatient units at a tertiary care academic medical center: the medical-surgical intensive care and abdominal solid organ transplant units. Unit-level data were collected retrospectively for 24 months pre-and post-fluoroquinolone restriction intervention, implemented in July 2016, for all admissions to the study units. Our restriction intervention required antimicrobial stewardship pre-approval for fluoroquinolone prescribing. We explored barriers and facilitators to optimal fluoroquinolone prescribing using semi-structured interviews attending, fellow and resident physicians, advanced practice providers and pharmacists on these units. Results Hospital-onset C. difficile infection did not decrease significantly, but fluoroquinolone use declined significantly from 111.6 to 19.8 days of therapy per 1000 patient-days without negatively impacting length of stay, readmissions or mortality. Third generation cephalosporin and aminoglycoside use increased post-restriction. Providers identified our institution's strong antimicrobial stewardship program and pharmacy involvement in antimicrobial

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“…Komitmen yang kuat dari pimpinan RS untuk memenuhi kebutuhan sumber daya penunjang sangat dibutuhkan untuk menjamin keberhasilan inisiasi dan keberlangsungan ASP [36]. Beberapa penelitian terpublikasi menunjukkan bahwa dukungan yang tidak optimal dari pimpinan RS berdampak pada ketidakoptimalan implementasi ASP [18,37].…”

Section: Tema 2: Relevansi Implementasi Asp Bagi Rumah Sakitunclassified

Persepsi Dokter tentang Strategi Antimicrobial Stewardship Program di Sebuah Rumah Sakit Umum di Surabaya

2020

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Antimicrobial Stewardship Program (ASP) dikembangkan untuk mengoptimalkan penggunaan antibiotik melalui implementasi kebijakan, strategi maupun pedoman. Penelitian ini bertujuan untuk mengkaji persepsi dokter terhadap ASP dan mengeksplorasi pilihan beserta pertimbangan pemilihan suatu jenis strategi ASP. Pendekatan kualitatif melalui wawancara dengan dokter yang aktif bekerja di sebuah rumah sakit umum di kota Surabaya dilakukan dengan bantuan panduan wawancara semi terstruktrur untuk mengeksplorasi: i) sikap terhadap implementasi ASP, dan ii) strategi ASP yang disarankan. Hasil wawancara diolah secara thematic analysis. Sebanyak 27 dokter bersedia terlibat. Secara umum, partisipan memiliki sikap yang baik terhadap implementasi ASP. Terdapat tiga tema terkait implementasi ASP, yaitu: 1) persetujuan implementasi sebagai konsekuensi dari bagian komunitas profesi di rumah sakit (RS); 2) relevansi implementasi bagi perbaikan kualitas RS, dan 3) tuntutan pemenuhan sumber daya sebelum diimplementasikan. Pembuatan pedoman terapi atau clinical pathway merupakan strategi yang paling banyak dipilih oleh partisipan. Pertimbangan dalam memilih suatu strategi adalah: 1) kesepakatan oleh komunitas RS; 2) practicability dan feasibility; dan 3) penggunaan bukti penelitian sebagai dasar penyusunan strategi. Penelitian ini memberikan gambaran mengenai persepsi dokter terkait dengan implementasi ASP. Diharapkan hasil penelitian ini dapat dijadikan sebagai salah satu acuan dalam merancang strategi ASP yang tepat dalam konteks RS di Indonesia.

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Facilitators and Barriers to Antibiotic Stewardship: A Qualitative Study of Pharmacists’ Perspectives

Cited by 18 publications

References 17 publications

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: A mixed-methods study

Persepsi Dokter tentang Strategi Antimicrobial Stewardship Program di Sebuah Rumah Sakit Umum di Surabaya

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