Outcomes associated with a thrice-weekly antimicrobial stewardship programme in a 253-bed community hospital

Vettese, N.; Hendershot, J.; Irvine, Maj Thomas; Wimer, Steven M.; Chamberlain, Digby; Massoud, Neil

doi:10.1111/jcpt.12079

Cited by 32 publications

(33 citation statements)

References 10 publications

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“…57,671 Collectively, their active stewardship of antibiotic prescribing is acknowledged to limit overprescribing 672 and improve adherence to guidelines. [673][674][675][676] However, their oversight of surgical prophylaxis is constrained by the charting and timing of the administration of such drugs within the theatre environment. [677][678][679] There are many other ways in which patients may acquire infections while in hospital.…”

Section: Reducing Health-care-associated Infectionmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Reducing Health-care-associated Infectionmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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“…Although a few integrative data sources were described [5,6], most were not developed and individualized for antimicrobial stewardship purposes. Studies that provided mention of ASP specific systems or databases [7][8][9][10][11][12][13][14] generally offered little description of their capacity for ASP evaluation and research.…”

Section: Data Sourcesmentioning

confidence: 99%

“…This tool was used to identify the levels of evidence for the publications included in this review. About half of the included studies (29/58) employed a before-and-after study design [6, 7, 9-11, 13, 14, 17-38], and 62 % (36/ 58) constituted level IV evidence [6,7,[9][10][11][12][13][14]. During the review period, there were no level I publications (systematic reviews of randomized controlled trials (RCTs)), and we identified only five (9 %) published RCTs (level II) [45, 46, 47•, 48, 49].…”

Section: Study Design Study Design and Hierarchy Of Evidencementioning

confidence: 99%

“…Other measures included antibiotic-free days [48], proportion of patients given antibiotics [32,48,49], number of antimicrobials given [33], and proportion of ICU days on antibiotics [46]. Where stewardship interventions targeted specific antimicrobials [7][8][9]20 [7, 9, 27, 29, 42, 47•, 50, 56•, 76]. Although measurement of non-targeted or total antimicrobials is more labor intensive than measuring targeted agents alone, this information is essential to allow for the detection of compensatory increases in the use of other agents, which can lead to the "squeezing the balloon" phenomenon [79].…”

Section: Metrics Process Measuresmentioning

confidence: 99%

“…Eleven studies estimated actual or potential cost savings in antimicrobial acquisition due to the stewardship intervention [7, 9, 10, 12, 22, 29, 41, 54, 55•, 80, 81]. A minority of studies reported the costs required to implement the stewardship intervention [9,41,81].…”

Section: Drug Costs/other Costsmentioning

confidence: 99%

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Walker

Leis

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Kubes

Castagnini

2018

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Outcomes associated with a thrice-weekly antimicrobial stewardship programme in a 253-bed community hospital

Abstract: A thrice-weekly, pharmacist-driven ASP can decrease antimicrobial expenditure, shorten duration of therapy and decrease the utilization of carbapenems, vancomycin and levofloxacin.

Cited by 32 publications

References 10 publications

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Antimicrobial Stewardship Programs: A Review of Recent Evaluation Methods and Metrics

Role of Antimicrobial Stewardship

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