Patient understanding of and participation in infection-related care across surgical pathways: a scoping review

Mbamalu, Oluchi; Bonaconsa, Candice; Nampoothiri, Vrinda; Surendran, Surya; Veepanattu, Pranav; Singh, Sanjeev; Dhar, Puneet; Carter, Vanessa; Boutall, Adam; Pennel, Timothy; Hampton, Mark; Holmes, Alison; Mendelson, Marc; Charani, Esmita

doi:10.1016/j.ijid.2021.07.039

Cited by 17 publications

(20 citation statements)

References 56 publications

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“…Although much is written about engaging patients on IPC and AMS in policies and guidelines, a recent scoping review suggests that current infection-related patient participation measures are limited, emphasizing the many missed opportunities for patient engagement. 43 , 44 …”

Section: Discussionmentioning

confidence: 99%

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Nampoothiri

Bonaconsa

Surendran

et al. 2021

JAC-Antimicrobial Resistance

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Background Whilst antimicrobial stewardship (AMS) is being implemented globally, contextual differences exist. We describe how the use of a massive open online course (MOOC) platform provided an opportunity to gather diverse narratives on AMS from around the world. Methods A free 3 week MOOC titled ‘Tackling antimicrobial resistance: a social science approach’ was launched in November 2019. Learners were asked specific questions about their experiences of AMS via 38 optional free-text prompts dispersed throughout the modules. Content analysis was used to identify key emerging themes from the learners’ responses in the first three runs of the MOOC. Results Between November 2019 and July 2020, 1464 learners enrolled from 114 countries. Overall, 199 individual learners provided a total of 1097 responses to the prompts. The diverse perspectives describe unique challenges present in different contexts including ill-defined roles for pharmacists and nurses in AMS; inadequate governance and policy inconsistencies in surveillance for antibiotic consumption and antimicrobial resistance (AMR) in some countries; lack of ownership of antibiotic decision-making and buy-in from different clinical specialties; and human resource and technological constraints. Patients’ knowledge, experiences and perspectives were recognized as a valuable source of information that should be incorporated in AMS initiatives to overcome cultural barriers to the judicious use of antibiotics. Conclusions Analysis of learner comments and reflections identified a range of enablers and barriers to AMS implementation across different healthcare economies. Common challenges to AMS implementation included the role of non-physician healthcare workers, resource limitations, gaps in knowledge of AMR, and patient engagement and involvement in AMS.

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Section: Discussionmentioning

confidence: 99%

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Nampoothiri

Bonaconsa

Surendran

et al. 2021

JAC-Antimicrobial Resistance

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“… 13 , 14 , 15 This less-than-ideal situation places patients at the risk of misidentifying potential postsurgical complications and concerns. 16 As a result, patients often seek care that they do not need or wait until minor issues develop into more substantial complications. Second, postsurgical RPM may help improve patient perspectives regarding their care.…”

Section: Discussionmentioning

confidence: 99%

Postsurgical Remote Patient Monitoring Outcomes and Perceptions: A Mixed-Methods Assessment

Spaulding¹,

Loomis²,

Brennan³

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…This understandably leads to a more defensive approach [ 74 ] which manifests as more and/or longer, potentially unnecessary, antimicrobial [treatment] courses [ 72 ]. Additionally, patients are almost always omitted from the decision-making process [ 4 , 61 , 64 ] echoing a recent scoping review that highlights the need for more patient (and carer) involvement in antimicrobial stewardship across the surgical pathway [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Tipping the balance: A systematic review and meta-ethnography to unfold the complexity of surgical antimicrobial prescribing behavior in hospital settings

et al. 2022

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Surgical specialties account for a high proportion of antimicrobial use in hospitals, and misuse has been widely reported resulting in unnecessary patient harm and antimicrobial resistance. We aimed to synthesize qualitative studies on surgical antimicrobial prescribing behavior, in hospital settings, to explain how and why contextual factors act and interact to influence practice. Stakeholder engagement was integrated throughout to ensure consideration of varying interpretive repertoires and that the findings were clinically meaningful. The meta-ethnography followed the seven phases outlined by Noblit and Hare. Eight databases were systematically searched without date restrictions. Supplementary searches were performed including forwards and backwards citation chasing and contacting first authors of included papers to highlight further work. Following screening, 14 papers were included in the meta-ethnography. Repeated reading of this work enabled identification of 48 concepts and subsequently eight overarching concepts: hierarchy; fear drives action; deprioritized; convention trumps evidence; complex judgments; discontinuity of care; team dynamics; and practice environment. The overarching concepts interacted to varying degrees but there was no consensus among stakeholders regarding an order of importance. Further abstraction of the overarching concepts led to the development of a conceptual model and a line-of-argument synthesis, which posits that social and structural mediators influence individual complex antimicrobial judgements and currently skew practice towards increased and unnecessary antimicrobial use. Crucially, our model provides insights into how we might ‘tip the balance’ towards more evidence-based antimicrobial use. Currently, healthcare workers deploy antimicrobials across the surgical pathway as a safety net to allay fears, reduce uncertainty and risk, and to mitigate against personal blame. Our synthesis indicates that prescribing is unlikely to change until the social and structural mediators driving practice are addressed. Furthermore, it suggests that research specifically exploring the context for effective and sustainable quality improvement stewardship initiatives in surgery is now urgent.

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Patient understanding of and participation in infection-related care across surgical pathways: a scoping review

Cited by 17 publications

References 56 publications

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

Postsurgical Remote Patient Monitoring Outcomes and Perceptions: A Mixed-Methods Assessment

Tipping the balance: A systematic review and meta-ethnography to unfold the complexity of surgical antimicrobial prescribing behavior in hospital settings

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