The Barriers in the implementation of Antimicrobial Stewardship Programs: A systematic Review

Abstract

Background The resistance to Antimicrobial is considered as one of the most important risks that affect public health and healthcare. Antimicrobial stewardship programs comprise a series of interventions that help to stop the inappropriate use of antimicrobials.Methods The published literature on the barriers of implementing stewardship programs is limited. We searched for the relevant articles from 2007 till the end of 2017 using the keyword “Antimicrobial Stewardship Programs" in PubMed database.Results There are many barriers in the implementation of antimicrobial stewardship programs. To improve the rational use of antibiotics it is important to overcome these barriers.Conclusion According to the included studies into current review or manuscript, there are 9 major barriers for ASPs. Lack of training and knowledge, inter-professional and inter-specialty conflict, and lack of resources are the most common barriers.

Determination of the Enablers and Challenges in the Implementation of Pharmacy-based Antimicrobial Stewardship (AMS) Program in a Level 3 Hospital in Manila

“…Good telehealth and internet access, the use of IT to implement strategies, the use of expert systems to provide patient-specific recommendations at the point of care, and IT support for antibiotic prescribing were identified as enablers for implementing AMS programs in hospitals, while the lack of IT resources (IT-based monitoring scheme for antibiotic use, and inaccurate or incomplete data access and data extraction) were the barriers identified in several studies. [9][10][11][12] It is then crucial to enhance the hospital's IT system to create and establish a more systematic and efficient process in providing interventions to patients, such as through the use of automation and artificial intelligence, and to facilitate the monitoring and reporting of performance indicators and outcomes. 13,14 These IT tools can be used to collate important patient information, including admission notes and nursing notes, previous hospital admission, vital signs, medication administration charts, laboratory and culture results and reports, clinical decision support system (CDSS) entries, clinical progress notes, referral letters, discharge dates, outpatient prescriptions, and outpatient visit notes, which can then allow prescribers to make more informed decisions on appropriate antimicrobial prescribing; hence, reducing the misuse and overuse of antimicrobials.…”

“…Funding is a crucial factor in the successful implementation of AMS programs, and this also includes financial compensation for additional time spent in AMS activities, and incentives to help support and retain staff. [9][10][11] The lack of funding will result in the lack of trained and dedicated pharmacists, which is also a problem reported by several respondents. Recommendations for increased funding and manpower may be dependent on the available budget and prioritization of the hospital administration.…”

The implementation of antimicrobial stewardship in Indonesia: a regional survey in hospitals

“…Healthcare institutions lack internal expertise with limited exposure to education and training [42]. According to a study conducted in [46]. Several limitations should be highlighted in our study.…”

Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs

“…There is general agreement regarding the need for and usefulness of ASPs, and that current antibiotics will remain useful for longer through such programs. However, there are still many obstacles to the effective operation of an ASP, including irregular work processes, such as excessive workload, time constraints, and decision fatigue; diagnostic barriers, social and ethical barriers; hospital hierarchies; lack of training and knowledge; communication between microbiology laboratories and clinical units; interprofessional and interspecialty conflict; and lack of resources [ 19 ].…”