Understanding surgical antimicrobial prescribing behaviour in the hospital setting: a systematic review and meta-ethnography protocol

Abstract

Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB amongst surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research. Methods The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or ‘piles’ which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful. Discussion This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care. Systematic review registration PROSPERO CRD42020184343

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

“…adult and pediatric care; higher and lower income countries; private and state funded health-services) giving us a broad perspective on surgical APB. It also means the findings are more likely to resonate with our target audience [ 44 ]. The involvement of multiple reviewers (including those with extensive qualitative/meta-ethnography experience) during screening and analysis, and at regular meetings throughout the research, adds rigor [ 40 , 86 ] and demonstrates our engagement with the interpretive nature of the data.…”

“…The meta-ethnography was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42020184343; and the published protocol [ 44 ] follows the seven meta-ethnography phases outlined by Nobit and Hare (1988). Some small innovations from the protocol were made (outlined below), e.g.…”

“…We conducted a systematic search focusing on qualitative studies that explored APB among surgical teams [ 44 ]. The SPIDER tool [ 49 ] provided structure and clarity for the search.…”

“…We used the screening criteria defined previously in our protocol [ 44 ]. However, we made an additional pragmatic decision to exclude studies with ≤50% surgical participants to ensure the findings were representative of surgical teams (see Table 2 ).…”

ePrescribing-Based Antimicrobial Stewardship Practices in an English National Health Service Hospital: Qualitative Interview Study Among Medical Prescribers and Pharmacists

“…These are designed to educate all health care practitioners around good AMS practices, to educate medical prescribers in appropriate antimicrobial use (eg, reducing the inappropriate use of broad-spectrum antimicrobials, optimization of doses or durations, regular review of antimicrobial prescriptions, and deprescribing or stopping antimicrobials), and to encourage adherence to guidelines. These AMS interventions are frequently supported by specific interactions within computerized physician order entry (CPOE) and clinical decision support (CDS) systems ( Textbox 1 ) [ 7 - 9 ].…”