A qualitative evaluation of frontline clinician perspectives toward antibiotic stewardship programs

Abstract

Objective: To examine the perspectives of caregivers that are not part of the antibiotic stewardship program (ASP) leadership team (eg, physicians, nurses, and clinical pharmacists), but who interact with ASPs in their role as frontline healthcare workers. Design: Qualitative semistructured interviews. Setting: The study was conducted in 2 large national healthcare systems including 7 hospitals in the Veterans’ Health Administration and 4 hospitals in Intermountain Healthcare. Participants: We interviewed 157 participants. The current analysis includes 123 nonsteward clinicians: 47 physicians, 26 pharmacists, 29 nurses, and 21 hospital leaders. Methods: Interviewers utilized a semistructured interview guide based on the Consolidated Framework for Implementation Research (CFIR), which was tailored to the participant’s role in the hospital as it related to ASPs. Qualitative analysis was conducted using a codebook based on the CFIR. Results: We identified 4 primary perspectives regarding ASPs. (1) Non-ASP pharmacists considered antibiotic stewardship activities to be a high priority despite the added burden to work duties: (2) Nurses acknowledged limited understanding of ASP activities or involvement with these programs; (3) Physicians criticized ASPs for their restrictions on clinical autonomy and questioned the ability of antibiotic stewards to make recommendations without the full clinical picture; And (4) hospital leaders expressed support for ASPs and recognized the unique challenges faced by non-ASP clinical staff. Conclusion: Further understanding these differing perspectives of ASP implementation will inform possible ways to improve ASP implementation across clinical roles.

How Should Clinicians Navigate Interprofessional Tension in Their Roles as Antimicrobial Stewards?

“…Thus, routine antimicrobial preauthorization review can lead to perceptions of infringement on prescriber and patient autonomy. 4,6,7 Ideally, antimicrobial stewardship pharmacists seek to balance prescribers' professional autonomy and their own duty to determine whether the ordered medication is the most appropriate choice. For the pharmacist, these internal and external tensions contribute to the cognitive dissonance that underpins moral distress.…”