Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

Abstract

Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists’ perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social–ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians’ prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists’ antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

“…Our data suggested a dearth of policies addressing antimicrobial stewardship, and poor enforcement of existing policies. Interventions might include adopting a national antimicrobial monitoring system, requiring consults with pharmacists who have antimicrobial stewardshipspecific expertise, providing financial incentives for infection prevention and reduced antimicrobial prescribing, or developing and requiring a national, standardized educational training for all antimicrobial dispensers (109)(110)(111)(112). Policy reform and legislation alone are not sufficient to facilitate widespread antimicrobial stewardship nor combat resistance; it is also necessary to change individual behaviors and the embedded cultural norms that encourage them.…”

Instant Gratification and Overtreating to Be Safe: Perceptions of U.S. Intensive Care Unit Pharmacists and Residents on Antimicrobial Stewardship

“…The implications of this work are numerous. Building upon discussion of empowering practitioners in their positions within the hospital-based hierarchy [ 29 , 30 , 31 ], we conclude that just as AMR has an impact spanning hierarchy and institutional bounds, antimicrobial stewardship should acknowledge the multifaceted nature of medical practice in intensive care unit patients. Antimicrobial stewardship was described in a broad and programmatic sense by participants.…”

A Review on the Role of Community Pharmacists on Antimicrobial Stewardship Programs

“…Formalizing the role of hospital pharmacists as antibiotic stewards and providing them with the required resources and training will capitalize on their untapped potential to enhance ASPs and further optimize antibiotic use in hospitals [22].…”

“…Pharmacist-led interventions were reported to lessen the duration of antibiotic therapy and the costs that come with it [20] [24]. Only establishing the role of pharmacists in AMS, along with supplying them with additional training and necessary resources, will enhance their potential as antibiotic stewards [22]. The majority of pharmacists agreed that "antimicrobial stewardship is essential to improve patient care" and further added that training must be exerted on the use of antimicrobials as half of the participants confessed that communication with the prescriber was needed as of unsureness of the antimicrobials prescription [30].…”