Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres

Ali, Majdi; Kalima, Pota; Maxwell, Simon

doi:10.1093/jac/dkl076

Cited by 35 publications

(36 citation statements)

References 9 publications

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“…In the present study, the fact that it was conducted in a university hospital can explain providers' high adherence to the protocol because it is a setting where the focus is on prescribers' training. The same was reported by Ali et al, 1 who showed that the most important infl uence for prescription choice in medical schools was teachers and senior doctors' guidance.…”

Section: Resultssupporting

confidence: 75%

Eventos adversos a antibióticos em pacientes internados em um hospital universitário

Louro

Romano-Lieber

Ribeiro³

2007

Rev. Saúde Pública

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Adverse events to antibiotics in inpatients of a university hospital ABSTRACTOBJECTIVE: Antibiotics are the most common drugs causing adverse events and they lead to problems to patients and additional costs of the health system. The aim of the study was to evaluate the occurrence of adverse events to antibiotics in inpatients of a hospital. METHODS:An extensive drug monitoring was conducted in adult inpatients taking antibiotics in the city of Maringá, Southern Brazil, from September 2002 to February 2003. Variables related to medications used, especially those related to antibiotic use and adverse events, were studied. Based on criteria for adequate antibiotic use, the observed events were classifi ed as adverse events, medication errors and near-misses. For the analysis of causality between drug administration and event occurrence Naranjo algorithm was used. RESULTS:A total of 87 patients were studied and 91 adverse events were identifi ed: three (3.3%) adverse drug reactions; seven (7.7%) medication errors; and 81 (89.0%) medication near-misses. Adverse drug reactions were related to the use of quinolones and likely according to Naranjo algorithm. The seven medication errors were associated to four inadequately prescribed doses and three drug interactions. CONCLUSIONS:The study results indicate that an inadequate knowledge on antibiotics or lack of information about the patient at the time of prescription were the major factors involved in the occurrence of adverse events.

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Section: Resultssupporting

confidence: 75%

Eventos adversos a antibióticos em pacientes internados em um hospital universitário

Louro

Romano-Lieber

Ribeiro³

2007

Rev. Saúde Pública

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“…In other words, as guided by our data, we recognise that these factors will always limit prescribing decisions and place more emphasis on solutions that can work in the face of uncertainty, inexperience and lack of knowledge. For the same reasons, our analysis draws less attention to uncertainty about technical aspects of the process of prescribing, [56][57][58][59] poor dissemination of information or conflicting guidelines and lack of awareness, 43,[60][61][62][63][64][65] and operational inefficiencies and pressures. 43,62,[66][67][68][69][70] Instead, we are looking to understand what drives the behaviour of doctors in training in the presence of these limitations -namely uncertainty, inexperience and lack of knowledge.…”

Section: Chapter 3 Findingsmentioning

confidence: 99%

“…The educational role of pharmacists 43,60,64,125,171,181 and infectious disease specialists 102 has been extensively discussed in the literature as critical for appropriate antimicrobial prescribing. Accepting antimicrobial prescribing more widely as 'a specialised act' 102 could significantly legitimise the input of antimicrobial specialists and contribute to their meaningful involvement.…”

Section: Input From Other Professional Groupsmentioning

confidence: 99%

“…As this review has highlighted, it makes a difference to the perceived credibility of guidelines if they have been approved by peers, include up-to-date information from accepted sources and resonate with clinical experience. 35,60,68 The literature reviewed suggests that use of guidelines can be strengthened further through active senior support, better communication to health professionals including junior doctors and ongoing evaluation. 43,60,62,103,106 Apart from the use of guidelines for decision support, some articles also advocate the use of information technology to improve prescribing and decrease medication errors.…”

Section: Antimicrobial Prescribing Support Aidsmentioning

confidence: 99%

“…35,60,68 The literature reviewed suggests that use of guidelines can be strengthened further through active senior support, better communication to health professionals including junior doctors and ongoing evaluation. 43,60,62,103,106 Apart from the use of guidelines for decision support, some articles also advocate the use of information technology to improve prescribing and decrease medication errors. 57,135,186 However, such arguments need to be treated with caution to avoid treating technology as a silver bullet.…”

Section: Antimicrobial Prescribing Support Aidsmentioning

confidence: 99%

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Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Papoutsi

Mattick

Pearson

et al. 2018

Health Serv Deliv Res

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BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Adherence to Guidelines on Empiric Use of Antibiotics in the Emergency Room

et al. 2008

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Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres

Abstract: This study highlights inadequacies in the implementation and promotion of local guidelines, and demonstrates the potential for widely varying antimicrobial practices in two comparable UK cities.

Cited by 35 publications

References 9 publications

Eventos adversos a antibióticos em pacientes internados em um hospital universitário

Eventos adversos a antibióticos em pacientes internados em um hospital universitário

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Adherence to Guidelines on Empiric Use of Antibiotics in the Emergency Room

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