A qualitative study of hospital pharmacists and antibiotic governance: negotiating interprofessional responsibilities, expertise and resource constraints

Abstract

BackgroundAntibiotic treatment options for common infections are diminishing due to the proliferation of antimicrobial resistance (AMR). The impact of Antimicrobial Stewardship (AMS) programs seeking to preserve viable antibiotic drugs by governing their use in hospitals has hitherto been limited. Pharmacists have been delegated a critical role in antibiotic governance in AMS teams within hospitals but the experience of pharmacists in influencing antibiotic use has received limited attention. In this study we explore the experiences of pharmacists in antibiotic decision-making in two Australian hospitals.MethodsWe conducted 19 semi-structured interviews to explore hospital-based pharmacists’ perceptions and experiences of antibiotic use and governance. The analysis was conducted with NVivo10 software, utilising the framework approach.ResultsThree major themes emerged in the pharmacist interviews including (1) the responsibilities of pharmacy in optimising antibiotic use and the interprofessional challenges therein; (2) the importance of antibiotic streamlining and the constraints placed on pharmacists in achieving this; and (3) the potential, but often under-utilised expertise, pharmacists bring to antibiotic optimisation.ConclusionsPharmacists have a critical role in AMS teams but their capacity to enact change is limited by entrenched interprofessional dynamics. Identifying how hospital pharmacy’s antibiotic gatekeeping is embedded in the interprofessional nature of clinical decision-making and limited by organisational environment has important implications for the implementation of hospital policies seeking to streamline antibiotic use. Resource constraints (i.e. time limitation and task prioritisation) in particular limit the capacity of pharmacists to overcome the interprofessional barriers through development of stronger collaborative relationships. The results of this study suggest that to enact change in antibiotic use in hospitals, pharmacists must be supported in their negotiations with doctors, have increased presence on hospital wards, and must be given opportunities to pass on specialist knowledge within multidisciplinary clinical teams.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1290-0) contains supplementary material, which is available to authorized users.

Knowledge, Attitude, and Practices on Antibiotic Resistance Among Pharmacists at the University Teaching Hospitals in Lusaka, Zambia

“…Our study revealed that the majority of pharmacists (48%) agreed and another (48%) strongly agreed that they collaborate with other healthcare professionals in infection control and Antimicrobial Stewardship Programmes (ASPs) with a p<0.001. Other researchers found similar results 25,27,39,40 . This is important as infection control and fighting of antimicrobial resistance requires a multi-sectoral approach and collaboration among healthcare practitioners 37 .…”

“…All the pharmacists in our study recommended that Antimicrobial Stewardship Programmes (ASPs) must be initiated and implemented in all healthcare facilities with a statistically significant p<0.001. Other studies have also shown that pharmacists recommended the initiation and implementation of ASPs 13,16,24,25,40 . The WHO has also emphasised that ASPs must be implemented in healthcare facilities and they play a vital role in fighting AMR 1 .…”

Infectious Disease Pharmaceutical Care: The Role of the Clinical Pharmacists to Improve Clinical Outcomes 2017

“…This includes the reallocation of resources to acknowledge hospital pharmacy's responsibilities beyond the dispensing of medicines and provide them with opportunities to accumulate specialized clinical experience. Increased presence of pharmacists on hospital wards across high resource and low resource settings would also allow the establishment and maintenance of trusting relationships between pharmacists and doctors that promotes a sense of shared obligation to the "patient good" and a mutual understanding as partners in the effort to curb the proliferation of AMR [14]. Brown et al "The looming antibioticresistance crisis has penetrated the consciousness of clinicians, researchers, policy makers, politicians and the public at large.…”

“…The impact of the addition of a clinical pharmacist to an antimicrobial control program was evaluated in a Veteran Affairs medical center [14]. Over a 2-year period, the pharmacist reviewed 1,329 orders for restricted and non-formulary antibiotics for appropriateness on the basis of presumed infection, culture results, formulary availability, and dosing.…”

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis

“…60 Kedua, dilihat dari perspektif tenaga kesehatan lain, khususnya apoteker, proses restriksi dapat menempatkan mereka pada posisi yang tidak nyaman karena mereka dapat dipersepsikan sebagai "pengawas peresepan antibitoik" dan berpotensi menyebabkan tidak harmonisnya hubungan dengan tenaga kesehatan lain, khususnya dokter. 62,63 Selain itu, sangat besar kemungkinan dijumpai pada berbagai setting pemberian layanan kesehatan bahwa apoteker berada pada posisi yang "tidak kuat" dalam melakukan negosisasi penggunaan antibiotik dengan dokter. 64 Dengan mempertimbangkan kemungkinan adanya tantangan terkait ketidaksamaan kedudukan dalam berkomunikasi (inequalities in power relations) antartenaga kesehatan di Indonesia sebagaimana juga ditemukan di negara Asia lainnya, jenis strategi prospective audit with intervention and feedback secara a priori memiliki potensi untuk diterapkan di Indonesia.…”