Abstract
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.
Highlights
Antibiotic treatment options for common infections are diminishing due to the proliferation of antimicrobial resistance (AMR)
P: It is the appropriate use of drugs, the right drug for the right indication for the right patient, and the right dose” (Senior, HP4). Another participant commented on what hospital pharmacy does: “... tackling issues when they come up; annotating your charts appropriately; contacting doctors when [prescribing]’s deemed inappropriate; asking for advice from people when you’re not sure; taking the time to look things up if you don’t know the answer yourself
The increasing selfperception of pharmacy as antibiotic gatekeeper opens up significant potential for individual pharmacists to influence antibiotic decision-making in everyday practice
Summary
Antibiotic 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. The repercussions for global health are immense, yet one of the drivers of the acceleration of antibiotic resistance remains elusive to change—the excessive and inappropriate use of antibiotics in health service settings. Research in Australian hospitals, for example, shows that while 50 % of all inpatients receive antibiotics [9], between 20–50 % of assessable prescriptions are inappropriate [10]
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