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Threatened efficiency not autonomy: Prescriber perceptions of an established pediatric antimicrobial stewardship program

Published online by Cambridge University Press:  28 March 2019

Julia E. Szymczak Open the ORCID record for Julia E. Szymczak [Opens in a new window] ,
Eimear Kitt ,
Molly Hayes ,
Kathleen Chiotos ,
Susan E. Coffin ,
Emily R. Schriver ,
Ashley M. Patton ,
Talene A. Metjian  and
Jeffrey S. Gerber
Julia E. Szymczak*
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Eimear Kitt
Affiliation:
Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Molly Hayes
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Kathleen Chiotos
Affiliation:
Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
Emily R. Schriver
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Ashley M. Patton
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Talene A. Metjian
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
*
Author for correspondence: Julia E. Szymczak, Email: [email protected]
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Abstract

Background:

Implementing antimicrobial stewardship programs (ASPs) can be challenging due to prescriber resistance. Although barriers to implementing new ASPs have been identified, little is known about how prescribers perceive established programs. This information is critical to promoting the sustainability of ASPs.

Objective:

To identify how prescribers perceive an established pediatric inpatient ASP that primarily utilizes prior authorization.

Methods:

We conducted a cross-sectional survey administered from February through June 2017 in a large children’s hospital. The survey contained closed- and open-ended questions. Descriptive statistics and thematic content analysis approaches were used to analyze responses.

Results:

Of 394 prescribers invited, 160 (41%) responded. Prescribers had an overall favorable impression of the ASP, believing that it improves the quality of care (92.4% agree) and takes their judgment seriously (73.8%). The most common criticism of the ASP was that it threatened efficiency (26.0% agreed). In addition, 68.7% of respondents reported occasionally engaging in workarounds. Analysis of 133 free-text responses revealed that prescribers perceived that interacting with the ASP involved too many phone calls, caused communication breakdowns with the dispensing pharmacy, and led to gaps between approval and dispensing of antibiotics. Reasons given for workarounds included not wanting to change therapy that appears to be working, consultant disagreement with ASP recommendations, and the desire to do everything possible for patients.

Conclusions:

Prescribers had a generally favorable opinion of an established ASP but found aspects to be inefficient. They reported engaging in workarounds occasionally for social and emotional reasons. Established ASPs should elicit feedback from frontline prescribers to optimize program impact.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 5 , May 2019 , pp. 522 - 527
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010;126:1067–1073.CrossRefGoogle ScholarPubMed
Levy, ER, Swami, S, Dubois, SG, Wendt, R, Banerjee, R. Rates and appropriateness of antimicrobial prescribing at an academic children’s hospital, 2007–2010. Infect Control Hosp Epidemiol 2012;33:346–353.CrossRefGoogle ScholarPubMed
Newland, JG, Gerber, JS, Weissman, SJ, et al. Prevalence and characteristics of antimicrobial stewardship programs at freestanding children’s hospitals in the United States. Infect Control Hosp Epidemiol 2014;35:265–271.CrossRefGoogle ScholarPubMed
McPherson, C, Lee, BR, Terrill, C, et al. Characteristics of pediatric antimicrobial stewardship programs: current status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative. Antibiotics (Basel) 2018;7(1). pii: e4.CrossRefGoogle ScholarPubMed
Pakyz, AL, Moczygemba, LR, VanderWielen, LM, Edmond, MB, Stevens, MP, Kuzel, AJ. Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study. Am J Infect Control 2014;42(10 Suppl):S257–S263.CrossRefGoogle ScholarPubMed
Kapadia, SN, Abramson, EL, Carter, EJ, et al. the expanding role of antimicrobial stewardship programs in hospitals in the United States: lessons learned from a multisite qualitative study. Joint Comm J Qual Patient Safety 2018;44:68–74.CrossRefGoogle ScholarPubMed
Katz, MJ, Gurses, AP, Tamma, PD, Cosgrove, SE, Miller, MA, Jump RLP. Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach. Clin Infect Dis 2017;65:1943–1951.CrossRefGoogle ScholarPubMed
James, R, Luu, S, Avent, M, Marshall, C, Thursky, K, Buising, K. A mixed methods study of the barriers and enablers in implementing antimicrobial stewardship programmes in Australian regional and rural hospitals. J Antimicrob Chemother 2015;70:2665–2670.CrossRefGoogle ScholarPubMed
Perozziello, A, Routelous, C, Charani, E, et al. Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study. Int J Antimicrob Agent 2018;51:829–835.CrossRefGoogle ScholarPubMed
Cantey, JB, Vora, N, Sunkara, M. Prevalence, characteristics, and perception of nursery antibiotic stewardship coverage in the United States. J Pediatr Infect Dis Soc 2017;6(3):e30–e35.Google ScholarPubMed
Broom, J, Broom, A, Plage, S, Adams, K, Post, JJ. Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study. J Hosp Infect 2016;93:418–422.CrossRefGoogle Scholar
Broom, J, Broom, A, Kirby, E, Gibson, AF, Post, JJ. How do hospital respiratory clinicians perceive antimicrobial stewardship (AMS)? A qualitative study highlighting barriers to AMS in respiratory medicine. J Hosp Infect 2017;96:316–322.CrossRefGoogle ScholarPubMed
Jeffs, L, Thampi, N, Maione, M, Steinberg, M, Morris, AM, Bell, CM. A qualitative analysis of implementation of antimicrobial stewardship at 3 academic hospitals: understanding the key influences on success. Can J Hosp Pharm 2015;68:395–400.Google ScholarPubMed
Metjian, TA, Prasad, PA, Kogon, A, Coffin, SE, Zaoutis, TE. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J 2008;27:106–111.Google Scholar
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed
Seemungal, IA, Bruno, CJ. Attitudes of housestaff toward a prior-authorization-based antibiotic stewardship program. Infect Control Hosp Epidemiol 2012;33:429–431.CrossRefGoogle Scholar
Bannan, A, Buono, E, McLaws, ML, Gottlieb, T. A survey of medical staff attitudes to an antibiotic approval and stewardship programme. Intern Med J 2009;39:662–668.CrossRefGoogle Scholar
Stach, LM, Hedican, EB, Herigon, JC, Jackson, MA, Newland, JG. Clinicians’ attitudes towards an antimicrobial stewardship program at a children’s hospital. J Pediatr Infect Dis Soc 2012;1:190–197.CrossRefGoogle Scholar
Steinberg, M, Dresser, LD, Daneman, N, et al. A national survey of critical care physicians’ knowledge, attitudes, and perceptions of antimicrobial stewardship programs. J Intensive Care Med 2014;31:61–65.CrossRefGoogle ScholarPubMed
StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.Google Scholar
NVivo qualitative data analysis software. QSR International Pty Ltd. Version 12, 2016.Google Scholar
Salsgiver, E, Bernstein, D, Simon, MS, et al. Knowledge, attitudes, and practices regarding antimicrobial use and stewardship among prescribers at acute-care hospitals. Infect Control Hosp Epidemiol 2018;39:316–322.CrossRefGoogle ScholarPubMed
Flannery, DD, Swami, S, Chan, S, Eppes, S. Prescriber perceptions of a pediatric antimicrobial stewardship program. Clin Pediatr (Phila) 2014;53:747–750.CrossRefGoogle ScholarPubMed
Venugopalan, V, Trustman, N, Manning, N, Hashem, N, Berkowitz, L, Hidayat, L. Administration of a survey to evaluate the attitudes of house staff physicians towards antimicrobial resistance and the antimicrobial stewardship programme at a community teaching hospital. J Glob Antimicrob Resist 2016;4:21–27.CrossRefGoogle Scholar
Szymczak, JE, Newland, JG. The social determinants of antibiotic prescribing. In: Barlam, TF, Neuhauser, MM, Tamma, PD, Trivedi, KK, eds. Practical Implementation of an Antibiotic Stewardship Program. Cambridge, UK: Cambridge University Press; 2018. Pp. 45–62.CrossRefGoogle Scholar
Sikkens, JJ, van Agtmael, MA, Peters, EJG, et al. Behavioral approach to appropriate antimicrobial prescribing in hospitals: the Dutch Unique Method for Antimicrobial Stewardship (DUMAS) participatory intervention study. JAMA Intern Med 2017;177:1130–1138.CrossRefGoogle ScholarPubMed
LaRosa, LA, Fishman, NO, Lautenbach, E, Koppel, RJ, Morales, KH, Linkin, DR. Evaluation of antimicrobial therapy orders circumventing an antimicrobial stewardship program: investigating the strategy of “stealth dosing.” Infect Control Hosp Epidemiol 2007;28:551–556.CrossRefGoogle Scholar
Calfee, DP, Brooks, J, Zirk, NM, Giannetta, ET, Scheld, WM, Farr, BM. A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme. J Hosp Infect 2003;55:26–32.CrossRefGoogle ScholarPubMed
Seemungal, IA, Bruno, CJ. Attitudes of housestaff toward a prior-authorization-based antibiotic stewardship program. Infect Control Hosp Epidemiol 2012;33:429–431.CrossRefGoogle Scholar
Cosgrove, SE, Seo, SK, Bolon, MK, et al. Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: a multicenter intervention. Infect Control Hosp Epidemiol 2012;33:374–380.CrossRefGoogle ScholarPubMed
Dixon-Woods, M, Suokas, A, Pitchforth, E, Tarrant, C. An ethnographic study of classifying and accounting for risk at the sharp end of medical wards. Soc Sci Med 2009;69:362–369.CrossRefGoogle ScholarPubMed
Broom, A, Gibson, AF, Broom, J, Kirby, E, Yarwood, T, Post, JJ. Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers. J Hosp Infect 2016;94:230–235.CrossRefGoogle ScholarPubMed
Szymczak, JE. Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety. Sociol Health Illn 2016;38:325–339.CrossRefGoogle ScholarPubMed
Kronman, MP, Banerjee, R, Duchon, J, et al. Expanding existing antimicrobial stewardship programs in pediatrics: what comes next. J Pediatr Infect Dis Soc 2018;7:241–248.CrossRefGoogle ScholarPubMed
Livorsi, DJ, Heintz, B, Jacob, JT, Krein, SL, Morgan, DJ, Perencevich, EN. Audit and feedback processes among antimicrobial stewardship programs: a survey of the Society for Healthcare Epidemiology of America research network. Infect Control Hosp Epidemiol 2016;37:704–706.CrossRefGoogle ScholarPubMed
Lennox, L, Maher, L, Reed, J. Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implement Sci 2018;13:27.CrossRefGoogle Scholar
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