Leveraging implementation science to advance antibiotic stewardship practice and research

Livorsi, Daniel J; Drainoni, Mari-Lynn; Reisinger, Heather Schacht; Nanda, Neha; McGregor, Jessina C.; Barlam, Tamar F.; Morris, Andrew M.; Szymczak, Julia E.

doi:10.1017/ice.2021.480

Cited by 23 publications

(27 citation statements)

References 73 publications

(78 reference statements)

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“…[11][12][13][14][15][16] These data are fundamental to optimizing the implementation of diagnostic test stewardship interventions. 17,18 Therefore, we performed a mixed-methods process evaluation concurrent with a diagnostic-test stewardship intervention focused on reducing inappropriate respiratory-culture orders in our tertiary-care PICU.…”

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confidence: 99%

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention

Chiotos

Marshall

Kellom

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: To conduct a process evaluation of a respiratory culture diagnostic stewardship intervention. Design: Mixed-methods study. Setting: Tertiary-care pediatric intensive care unit (PICU). Participants: Critical care, infectious diseases, and pulmonary attending physicians and fellows; PICU nurse practitioners and hospitalist physicians; pediatric residents; and PICU nurses and respiratory therapists. Methods: This mixed-methods study was conducted concurrently with a diagnostic stewardship intervention to reduce the inappropriate collection of respiratory cultures in mechanically ventilated children. We quantified baseline respiratory culture utilization and indications for ordering using quantitative methods. Semistructured interviews informed by these data and the Consolidated Framework for Implementation Research (CFIR) were then performed, recorded, transcribed, and coded to identify salient themes. Finally, themes identified in these interviews were used to create a cross-sectional survey. Results: The number of cultures collected per day of service varied between attending physicians (range, 2.2–27 cultures per 100 days). In total, 14 interviews were performed, and 87 clinicians completed the survey (response rate, 47%) and 77 nurses or respiratory therapists completed the survey (response rate, 17%). Clinicians varied in their stated practices regarding culture ordering, and these differences both clustered by specialty and were associated with perceived utility of the respiratory culture. Furthermore, group “default” practices, fear, and hierarchy were drivers of culture orders. Barriers to standardization included fear of a missed diagnosis and tension between practice standardization and individual decision making. Conclusions: We identified significant variation in utilization and perceptions of respiratory cultures as well as several key barriers to implementation of this diagnostic test stewardship intervention.

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confidence: 99%

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention

Chiotos

Marshall

Kellom

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…A thorough review of implementation science strategies for AMS diagnostic stewardship can be found elsewhere. [55][56][57] Instead, this section will focus on pragmatic implementation considerations based on the experiences of two independent medical systems. These considerations assume that clinical microbiology laboratories have already made the decision to implement specific mRDT panels and will focus on how AMS programs can best leverage these technologies to improve patient outcomes locally.…”

Section: Pr Ac Tic Al Ams Cons Ider Ations For Implementing Mrdts Wit...mentioning

confidence: 99%

“…When considering how to optimize the use of mRDTs within either a hospital or health system, there are several important phases of implementation that must be planned to ensure both immediate incorporation and sustained impact. A thorough review of implementation science strategies for AMS diagnostic stewardship can be found elsewhere 55–57 . Instead, this section will focus on pragmatic implementation considerations based on the experiences of two independent medical systems.…”

Section: Practical Ams Considerations For Implementing Mrdts Within H...mentioning

confidence: 99%

From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing

et al. 2023

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Antimicrobial stewardship (AMS) programs have been quick to adopt novel molecular rapid diagnostic technologies (mRDTs) for bloodstream infections (BSIs) to improve antimicrobial management. As such, most of the literature demonstrating the clinical and economic benefits of mRDTs for BSI is in the presence of active AMS intervention. Leveraging mRDTs to improve antimicrobial therapy for BSI is increasingly integral to AMS program activities. This narrative review discusses available and future mRDTs, the relationship between the clinical microbiology laboratory and AMS programs, and practical considerations for optimizing the use of these tools within a health system. Antimicrobial stewardship programs must work closely with their clinical microbiology laboratories to ensure that mRDTs are used to their fullest benefit while remaining cognizant of their limitations. As more mRDT instruments and panels become available and AMS programs continue to expand, future efforts must consider the expansion beyond traditional settings of large academic medical centers and how combinations of tools can further improve patient care.

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“…There are numerous opportunities to accelerate the implementation of evidence‐based interventions in pharmacy. Potential targets for the application of IS models and methods to advance pharmacy practice and care delivery include iterative design and evaluation of different models for pharmacist‐led chronic disease management in outpatient clinics and transitions of care services, de‐prescribing of inappropriate medications in older adults, antibiotic stewardship, applying clinically relevant pharmacogenomic recommendations that promote health equity, or improving population health using value‐based reimbursement metrics 10‐12 . A recent review of factors influencing the implementation of innovations in community pharmacies identified important barriers to nationwide implementation, including pharmacy staff engagement with the innovation, resources needed for successful operationalization of the innovation, and external engagement (eg, the perceptions of patients and other health care professionals and their relationship with the community pharmacy) with implemented innovations 13 …”

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confidence: 99%

“…relevant pharmacogenomic recommendations that promote health equity, or improving population health using value-based reimbursement metrics. [10][11][12] A recent review of factors influencing the implementation of innovations in community pharmacies identified important barriers to nationwide implementation, including pharmacy staff engagement with the innovation, resources needed for successful operationalization of the innovation, and external engagement (eg, the perceptions of patients and other health care professionals and their relationship with the community pharmacy) with implemented innovations. 13 IS is defined as "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services".…”

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Research and scholarly methods: Implementation science studies

Kuo

Trinkley

Rabin

2022

J Am Coll Clin Pharm

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Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence‐based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (a) evidence‐based intervention; (b) implementation strategies; (c) IS theory, model, or framework; (d) IS outcomes and measures; and (e) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (a) pre‐implementation; (b) implementation; and (c) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE‐AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster‐randomized trial comparing two clinical decision support tools to improve guideline‐concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies, as well as IS‐related learning resources.

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Leveraging implementation science to advance antibiotic stewardship practice and research

Cited by 23 publications

References 73 publications

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention

From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing

Research and scholarly methods: Implementation science studies

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