Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: A human factors analysis in two intensive care units

Abstract

Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such as Clostridioides difficile (CDI); this is particularly important for fluoroquinolones (FQ), which are frequently used in critical care settings. In this study, using a multiple case study research approach, we conduct an in-depth analysis of an intervention aimed at limiting ICU prescriber access to FQ in two ICUs of two hospitals. The data collection and analysis were guided by a human factors engineering approach based on the SEIPS (Systems Engineering Initiative for Patient Safety) model and evidence-based implementation principles. Our results show some differences in the implementation of the FQ intervention between the two ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped to quickly identify problems with the intervention and ensure that changes were made in a just-in-time manner (e.g. just-in-time training, removal of FQ in order set for pneumonia). Despite their organizational differences, both sites developed strategies to successfully implement the FQ intervention.

Using a human-factors engineering approach to evaluate environmental cleaning in Veterans’ Affairs acute and long-term care facilities: A qualitative analysis

“…A recent report by our group demonstrated the use of SEIPS to evaluate an antimicrobial stewardship intervention to reduce fluoroquinolone prescriptions in intensive care units. 38 Successful implementation strategies utilized in this project mirrored those identified to be important in our study: leadership, communication, education, and feedback. Future research should evaluate similar implementation or quality initiatives utilizing these strategies when targeting individual work-system components of cleaning, especially those designed to standardize processes that overcome barriers and incorporate best practices.…”

A tale of 2 digital hospitals: A qualitative study of antimicrobial stewardship teams

“…10 The SEIPS model provides a framework to understand work systems, processes and outcomes in health care, and has been used extensively in patient safety and AMS research. 11,12 The work system comprises 5 elements: individuals; tasks; tools and technology; the organization; and the environment (Table 1). By employing this model to examine the AMS team and their operations, the researchers could adopt a systemsthinking approach, enabling a comprehensive understanding of the factors that contribute to the success of AMS.…”

“…A contextual inquiry methodological approach was used, including observations and semistructured interviews informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model 10 . The SEIPS model provides a framework to understand work systems, processes and outcomes in health care, and has been used extensively in patient safety and AMS research 11,12 . The work system comprises 5 elements: individuals; tasks; tools and technology; the organization; and the environment (Table 1).…”