Exploring the practice, confidence and educational needs of hospital pharmacists in reviewing antimicrobial prescribing: a cross-sectional, nationwide survey

Abstract

Background Antimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists’ self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions. Methods We conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models. Results There were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24–72 h of prescription; p < 0.001. Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimization based on infection-specific factors, bug-drug mismatch, and inappropriate lack of spectra of antimicrobial activity. The median knowledge score (correct answers to knowledge questions) was 6 out of 9 (interquartile range, 5–7); key gaps were noted in antimicrobials’ anaerobic spectrum, beta-lactam allergy assessment and dosing in immunocompromised patients. Clinical practice in inpatient areas, registration for 3–5 years and receipt of recent AMS education were associated with higher knowledge scores. More interactive modes of education delivery were preferred over didactic modes; p ≤ 0.01. Conclusion Gaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.

Coaching ward pharmacists in antimicrobial stewardship: A pilot study

“…Consistent with this, a recent national survey of Australian hospital pharmacists determined that those with two years or less of registration lacked the confidence to identify AMS interventions compared to more experienced hospital pharmacists. 12 However, in our study, pharmacists with more than two years of experience also reported benefits from coaching.…”

“… 9 , 10 In the Australian pharmacist survey mentioned above, interactive modes of education delivery such as a rotation in ID/AMS under supervision, one-on-one mentoring/coaching, and interactive small groups were perceived by a higher proportion of respondents to be useful or very useful than more didactic options such as lectures and e-learning modules. 12 Similarly, in the Malaysian study, a higher proportion of survey respondents preferred to learn about AMS via hands-on, experiential, or mentoring activities. 13 This pilot study aimed to describe for the first time the use of an interactive educational coaching approach to AMS targeted at ward pharmacists.…”

“… 10 However, AMS is not a mandatory component of the undergraduate pharmacy curriculum in Australia, 11 and a recently published Australian survey of 439 hospital pharmacists identified gaps in their AMS practice, confidence and knowledge. 12 Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimisation based on infection-specific factors, bug-drug mismatch (i.e., inappropriate microbe and antimicrobial combination), and inappropriate lack of spectra of antimicrobial activity. Key knowledge gaps were noted in antimicrobials' anaerobic spectrum and beta-lactam allergy assessment.…”

Pharmacists’ Perceptions of Handling Antimicrobial Resistance (AMR): A Case Study in Saudi Arabia

“…Moreover, less than half were confident in changing the antimicrobial spectrum in particular and overall junior pharmacists lack confidence in identifying AMS intervention compared with more experienced pharmacists. 7 This study results highlighted the necessity to address gaps in undergraduate curricula in AMS and AMR field. Another study, in Qatar, indicated there were many gaps between AMS education and clinical practice, and recommended making AMS and AMR compulsory elements on undergraduate curricula.…”

“…11 Another study assessed pharmacists AMS knowledge also clearly highlighted the gap in undergraduate curricula regarding this subject. 7 Thus, it may be suggested that pharmacy colleges curriculum content of infectious diseases such as AMR and AMS be assessed by qualified and experienced pharmacists in the field, from both clinical practice and academia. Also, the 2017 KSA MoH recommendation to pharmacy colleges should be monitored, evaluated, improved and studied.…”