Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study (original) (raw)
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Survey of physician and pharmacist steward perceptions of their antibiotic stewardship programs
Antimicrobial Stewardship & Healthcare Epidemiology, 2021
Objective: To examine how individual steward characteristics (eg, steward role, sex, and specialized training) are associated with their views of antimicrobial stewardship program (ASP) implementation at their institution. Design: Descriptive survey from a mixed-methods study. Setting: Two large national healthcare systems; the Veterans’ Health Administration (VA) (n = 134 hospitals) and Intermountain Healthcare (IHC; n = 20 hospitals). Participants: We sent the survey to 329 antibiotic stewards serving in 154 hospitals; 152 were physicians and 177 were pharmacists. In total, 118 pharmacists and 64 physicians from 126 hospitals responded. Methods: The survey was grounded in constructs of the Consolidated Framework for Implementation Research, and it assessed stewards’ views on the development and implementation of antibiotic stewardship programs (ASPs) at their institutions We then examined differences in stewards’ views by demographic factors. Results: Regardless of individual fact...
Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship
Journal of the American Association of Nurse Practitioners
Background: Antibiotic stewardship (ABS) is a set of strategies to optimize the use of antibiotics with the goal of reducing antibiotic resistance, improving patient outcomes and decreasing unnecessary costs. ABS affects all venues of patient care, including outpatient, inpatient, and long-term care. While many strategies for ABS exist and best practice continues to evolve, successful ABS programs utilize a multidisciplinary approach. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. The purpose of this study is to describe the knowledge, attitudes, and perceptions of NPs towards ABS. Methods: A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey developed for use in a previous study conducted at a university-affiliated hospital in Florida. Descriptive statistics were used to assess normality. Chi-Square test of independence was used to test differences categorical scores by NP setting, gender, and level of education. Pearson r correlation was completed to measure the relationship between age and years in practice. Results: Two hundred NPs completed the questionnaire (88% female; 70% Master's degree). The range of experience was 0-45 years (mean 11 years). Most NPs worked in a private office (23%) or community setting (29%). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). NPs in this study also based their antibiotic decisions on the antibiogram (63%) in their setting, while 56% indicated they start with broad spectrum and tailor antibiotic choices when culture results are received. NPs reported understanding that inappropriate use of antibiotics causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important for their job (94%) and felt confident in their use of antibiotics (86%). However, while 94% of respondents somewhat or strongly agreed that antibiotics are overused nationally, only 62% thought antibiotics were overused in their health care setting. Conclusion: In this study, most NPs reported that antibiotic resistance is a problem and antibiotics are overused nationally. Fewer believe that antibiotic resistance is a problem locally and fewer still that they, personally, contribute to the problem. NPs recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.
International journal of clinical pharmacy, 2012
Background Antimicrobial stewardship programs (ASP) have been implemented to promote rational use of antimicrobial drugs. Multidisciplinary teams are needed to form effective committees. Objective Assess the impact of ASP, with and without the presence of a pharmacist, in a cardiology hospital in Brazil. Methods The program started with an infectious disease (ID) physician, and after 22 months, a pharmacist started to work in the ASP team. We present data related to: stage 1-before the program implementation; stage 2-with the ID physician; and stage 3 with the inclusion of a pharmacist. Analysis was made by segmented regression of time series. Results After the start of ASP there was a significant reduction of consumption of all antimicrobials. The pharmacist contributed to the significant reduction in consumption of fluoroquinolones, clindamycin and ampicillin/sulbactam and in increase in total cephalosporins use in stage 3. Adherence rate to the ASP team recommendations was 64.1%....
Antibiotics
This study aimed to evaluate health professionals’ perceptions regarding the level of implementation of the Antimicrobials Stewardship (AMS) programs in Jordanian tertiary hospitals and to assess the perceived barriers to its implementation. During this cross-sectional study, a total of 157 healthcare providers agreed to participate (response rate 96.3%). Participants were asked to complete an electronic survey after meeting them at their working sites. Only 43.9% of the healthcare providers (n = 69) reported having an AMS committee in their hospital settings. The results suggested that private hospitals have significantly better AMS implementation compared to public hospitals among four areas (p ≤ 0.05). Moreover, the results showed that the most widely available strategies to implement AMS were infectious disease/microbiology advice (n = 112, 71.3%), and treatment guidelines (n = 111, 70.7%). Additionally, the study revealed that the main barrier to AMS implementation was the lack...
Infection Prevention in Practice Volume 1, Issues 3–4, December 2019, 100025, 2019
Antimicrobial stewardship programs (ASP) are an essential practice to prevent increasing resistance against antibiotics. A successful ASP monitors not only prescribing patterns and practices but also contributes in minimizing the toxic effects of antibiotics. Moreover, ASP also facilitates the selection of disease specific antibiotics and enforces rules and regulations to rationalize the use of antibiotics. The aim of the study is to highlight the core elements of Hospital Antibiotic Stewardship Programs in Karachi. The key elements proposed by center of disease control (CDC) such as; leadership, accountability, drug expertise, actions to support optimal antibiotic use, tracking (monitoring antibiotic prescribing, use and resistance), reporting information to staff on improving antibiotic use and resistance and education were evaluated on Yes/No scale. The data was collected from 44 hospitals of different categories in Karachi and all the major elements were studied. It was observed that all the hospitals in one setting failed to comply with all the guidelines. It has been concluded that efforts should be made to design ASP at each hospital and implemented through suitable policies and procedures.
Open Forum Infectious Diseases, 2020
Background Antibiotic stewardship programs (ASPs) are required at every hospital regardless of size. We conducted a qualitative study across different hospital settings to examine perspectives of physician and pharmacist stewards about the dynamics within their team and contextual factors that facilitate the success of their programs. Methods Semistructured interviews were conducted in March–November 2018 with 46 ASP stewards, 30 pharmacists, and 16 physicians, from 39 hospitals within 2 large hospital systems. Results We identified 5 major themes: antibiotic stewards were enthusiastic about their role, committed to the goals of stewardship for their patients and as a public-health imperative, and energized by successful interventions; responsibilities of pharmacist and physician stewards are markedly different, and pharmacy stewards performed the majority of the day-to-day stewardship work; collaborative teamwork is important to improving care, the pharmacists and physicians suppor...
Antimicrobial Stewardship: A Matter of Process or Outcome?
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2012
The risk of antimicrobial resistance and superinfection is increasing alongside rates of hospital-acquired infection. Imprudent antibiotic use combined with few novel antimicrobials can speed resistance. Antimicrobial stewardship programs (ASPs) advocate for judicious use of available antimicrobials to preserve their usefulness. Decreased antibiotic expenditures was the backbone of early justification for ASPs, but the function of these programs has evolved into measuring the quality and appropriateness of antimicrobial use. Proper evaluation of an ASP helps to inform which methods work best for a particular institution and can help to define best practices at a more global level. Study design and duration limitations, however, can make it difficult to measure the impact of these programs. Process measures have been validated and can evaluate quality of care; however, they do not adequately describe the clinical impact of these programs at the patient level. Outcome measures also have limitations; they are not a direct measure of quality of care. Therefore, both process and outcome measures need to be defined and assessed when evaluating an ASP to confirm that goals of the intervention are attained and clinical objectives are met. Most available well-designed studies judging the effectiveness of ASPs use process measures alone. Adding improvements in clinical outcomes to process measures would theoretically attract the attention of a broader audience and provide additional support to expand current ASPs and develop novel ASPs.
Antimicrobial Resistance & Infection Control
Background An effective use of surgical antibiotic prophylaxis (SAP) appears essential to prevent the development of infections linked to surgery while inappropriate and excessive prescriptions of prophylactic antibiotics increase the risk of adverse effects, bacterial resistance and Clostridium difficile infections. In this study, we aimed to analyze SAP practices in an acute secondary hospital in Belgium during the years 2016–2021 in order to evaluate the impacts of combined stewardship interventions, implemented thanks to a physician-pharmacist collaboration. Methods A quasi-experimental study on SAP practices was conducted during 5 years (2016–2021) in a Belgian University Hospital. We first performed a retrospective observational transversal study on a baseline group (2016.1–2016.4). Then, we constituted a group of patients (2017.1–2017.4) to test a combined intervention strategy of stewardship which integrated the central role of a pharmacist in antibiotic stewardship team and...
American Journal of Infection Control, 2018
Background: Nursing engagement in antibiotic stewardship programs (ASPs) remains suboptimal. The purpose of this study was to determine the knowledge, attitudes, and practices of nursing staff members regarding ASPs and identify barriers to their participation in such programs. Methods: This cross-sectional study was conducted at Virginia Commonwealth University Health System, an 860-bed tertiary care academic center located in Richmond, Virginia, where a well-resourced ASP has been in place for 2 decades. A survey consisting of 12 questions was administered to nursing staff via REDCap (Research Electronic Data Capture) in February 2018. Results: A total of 159 survey responses were included in the study. The results demonstrated gaps in knowledge regarding antibiotic stewardship (AS) and highlighted the importance of improving communication between nurses and ASPs. Overall, 102 (64.15%) of the study participants indicated familiarity with AS. Time constraints and concerns over physician pushback were identified as major barriers to participation. Conclusions: Many nurses were unaware of our center's ASP. Nurses identified activities falling within their daily workflow as potential areas for contribution to ASPs. Key barriers to participation were also identified. These data will inform efforts to engage nursing in AS activities at our medical center.