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Abstract
Thailand is currently facing the emergence of antimicrobial resistance. To address this issue the Thai government has supported the introduction of antimicrobial stewardship (AMS) programs. Little is known about the perceptions of key-stakeholders regarding the current clinical governance of AMS and the barriers and facilitators to embedding AMS into clinical care. The aim of this study was to explore organizational leaders’ and clinical nurses’ perceptions of the AMS clinical governance structure and activities at a tertiary referral centre in Thailand. Semi-structured interviews and focus group discussions were conducted with 15 organizational leader interviews and three focus groups involving 18 nurses. Four themes emerged from the data: (1) executive seemed to endorse but not support AMS activities; (2) lack of AMS policy and resources to optimize antibiotic prescribing, tracking and reporting; (3) lack of multidisciplinary engagement in the AMS team; and (4) lack of clinician expertise and education about AMS is a major hurdle. Key issues identified included: the need to develop and embed formal AMS policies; the need for organizational investment in personnel, information management systems, and staff education; and the need to establish a multidisciplinary approach to AMS with identifiable roles and responsibilities for each member of the team.
Highlights
Antimicrobial resistance (AMR) is considered by the World Health Organization (WHO) to be a major issue in healthcare.[1]
Participants were asked to consider the strengths and weaknesses of current clinical governance related to Antimicrobial stewardship (AMS) within the hospital
Executive seem to endorse but not support AMS activities One of the barriers identified by the organisational leaders to implementing a sustainable AMS program was that the hospital executive group seem to endorse having an AMS program but did not provide additional support for program development
Summary
Antimicrobial resistance (AMR) is considered by the World Health Organization (WHO) to be a major issue in healthcare.[1]. Thailand is currently facing the challenge of treating and preventing infections while reducing the emergence and spread of AMR.[4] In Thailand the prevalence of extensively antibiotic resistant strains of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillinresistant Staphylococcus aureus is increasing and is associated with increased acute care costs and patient mortality.[4] To address this issue the Royal Thai government and health care services have supported a number of initiatives aimed at raising awareness of the importance of AMS in the Thai healthcare context
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