Guarding the Goods: an Introduction to Antimicrobial Stewardship

Wang, Jeffrey S.; Bearman, Gonzalo; Edmond, Michael B.; Stevens, Michael P.

doi:10.1016/j.clinmicnews.2012.05.004

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…However, recent changes to antibiotic governance with a focus on altering doctors’ behaviour have had limited success. Our previous research revealed the significance of other stakeholders in antibiotic decision-making [ 17 ], and a variety of AMS approaches acknowledge, in particular pharmacists’ potential to make a meaningful contribution to streamlining antibiotics use [ 11 , 12 , 14 , 20 ]. This study reveals three important insights into hospital-based pharmacists’ experiences of antibiotic prescribing.…”

Section: Discussionmentioning

confidence: 99%

“…In the past decade a range of clinical governance programs aiming at optimising antimicrobial use in hospitals have been developed under the umbrella term of antimicrobial stewardship (AMS) [ 11 – 16 ]. These initiatives have focused largely on influencing doctors’ behaviour given that they are the prescribers [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…While there is research emerging regarding the complex factors that influence doctors’ antibiotic decisions [ 17 ], including institutional norms limiting practice change [ 19 ], there has been little examination of the experiences of non-physician stakeholders [ 20 , 21 ]. As shown in the results presented below, hospital work is interprofessional in character and effective antibiotic governance requires a multidisciplinary approach [ 11 , 12 , 14 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pharmacy is an increasingly important stakeholder at the bedside alongside nursing and medicine shifting professional focus to pharmaceutical care and individual patients’ drug therapy [ 25 – 27 ]. More recently, pharmacists began to assume additional responsibilities in the governance of antibiotics including controlling the availability of drugs in the hospital [ 11 ], education and raising awareness about AMR among nursing and medical staff [ 22 ], and providing audit and feedback regarding antibiotic use [ 10 , 14 , 22 ]. However, despite these shifts it is unclear how and in what ways pharmacists are influencing antibiotic prescribing, directly and indirectly.…”

Section: Introductionmentioning

confidence: 99%

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

Broom

Plage

Broom

et al. 2015

BMC Health Serv Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Broom

Plage

Broom

et al. 2015

BMC Health Serv Res

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40 Years of the Clinical Microbiology Newsletter

Forbes

Weissfeld

2018

Clinical Microbiology Newsletter

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The learning hospital: From theory to practice in a hospital infection prevention program

Hess

Srivastava

Pryor

et al. 2019

Infect. Control Hosp. Epidemiol.

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The learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.

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Guarding the Goods: an Introduction to Antimicrobial Stewardship

Cited by 6 publications

References 24 publications

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

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

40 Years of the Clinical Microbiology Newsletter

The learning hospital: From theory to practice in a hospital infection prevention program

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