A Qualitative Analysis of Implementation of Antimicrobial Stewardship at 3 Academic Hospitals: Understanding the Key Influences on Success

Abstract

Background: Inappropriate use of antimicrobials is linked to the development and spread of drug-resistant pathogens and is associated with increased morbidity, mortality, lengths of hospital stay, and health care costs. "Antimicrobial stewardship" is the umbrella term for an evidencebased knowledge translation strategy involving comprehensive quality improvement activities to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquired infections such as Clostridium difficile, and decrease health care costs. Objective: To assess the perceptions and experiences of antimicrobial stewardship program leaders in terms of clinicians' attitudes toward and behaviours related to antimicrobial prescribing. Methods: In this qualitative study, semistructured interviews were conducted with 6 antimicrobial stewards (2 physicians and 4 pharmacists) at 3 academic hospitals between June and August 2013. Results: The following 3 key themes emerged from the interviews: getting the right people on board, building collegial relationships, and rapidly establishing a track record. The study results elucidated the role and mechanisms that the program leader and other antimicrobial stewards used to influence other clinicians to engage in effective utilization of antimicrobials. The results also highlighted the methods employed by members of the antimicrobial stewardship team to tailor their strategies to the local context and to stakeholders of participating units; to gain credibility by demonstrating the impact of the antimicrobial stewardship program on clinical outcomes and cost; and to engage senior leaders to endorse and invest in the antimicrobial stewardship program, thereby adding to the antimicrobial stewards' credibility and their ability to influence the uptake of effective antimicrobial use. Conclusions: Collectively, these results offer insight into processes and mechanisms of influence employed by antimicrobial stewards to enhance antimicrobial use among clinicians, which can in turn inform future implementation of antimicrobial stewardship and strategies for organizational change in hospitals.

The Expanding Role of Antimicrobial Stewardship Programs in Hospitals in the United States: Lessons Learned from a Multisite Qualitative Study

“…22 Previous data from international and American settings suggest that resource limitations, lack of executive leadership support, and cultural barriers regarding antimicrobial prescribing are major challenges for successful ASP implementation. [23][24][25][26] However, it is not known how leading ASPs are evolving strategies to overcome these barriers in the face of technological innovation and ongoing regulatory and accreditation requirements. We used qualitative methods to identify and describe characteristics of leading ASPs and novel strategies for stewardship.…”

Impact of Empowering Leadership on Antimicrobial Stewardship: A Single Center Study in a Neonatal and Pediatric Intensive Care Unit and a Literature Review

“…All five studies are in line with the conclusion that an empowering leadership style in one way or another does lead to a higher engagement of staff and/or stakeholders. To share or distribute responsibilities on every team member, it is important to build personal relationships within a team ( 34 ) and to establish a penalty free learning culture ( 37 ). Positive impacts were reported on culture changes and on AMS topics such as MRSA prevention ( 35 ), reduction of nosocomial infections ( 37 ) and CLABSI ( 36 ).…”

Variation in antibiotic use across intensive care units (ICU): A population-based cohort study in Ontario, Canada

“…Newly implemented ASPs should consider applying the established criteria when evaluating the appropriateness of antibiotic consumption. 30,33 Finally, although the ICUs in our study are representative of the ICUs in Canada, we look forward to future studies that examine the differences in antimicrobial use across ICUs in other countries.…”

“…In particular, understanding how modifiable factors such as physicians' prescribing pattern in ICUs and ICU regulatory policies impact antibiotic use would be valuable as they present opportunities for change. 33 Second, wide variation exists in the amount of antibiotic use across ICUs, and it is unclear if whether variation exists in the duration of antibiotic use and whether such variation contributes to the inappropriate use at the ICU level. Further, although ASPs are associated with reduced antibiotic consumption and costs in some academic ICUs, 11 this finding can be further validated on a large scale in academic and community ICUs.…”