Abstract
BackgroundAntimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists’ self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions.MethodsWe conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models.ResultsThere were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24–72 h of prescription; p < 0.001. Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimization based on infection-specific factors, bug-drug mismatch, and inappropriate lack of spectra of antimicrobial activity. The median knowledge score (correct answers to knowledge questions) was 6 out of 9 (interquartile range, 5–7); key gaps were noted in antimicrobials’ anaerobic spectrum, beta-lactam allergy assessment and dosing in immunocompromised patients. Clinical practice in inpatient areas, registration for 3–5 years and receipt of recent AMS education were associated with higher knowledge scores. More interactive modes of education delivery were preferred over didactic modes; p ≤ 0.01.ConclusionGaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.
Highlights
Antimicrobial stewardship (AMS) programs are usually limited in resources and scope
Wider engagement of frontline healthcare providers not directly involved in AMS programs, including hospital pharmacists, is necessary to ensure optimal use of antimicrobials, especially those agents not routinely reviewed by AMS teams [7]
Survey tool and administration A 38-item survey (Additional file 1) was designed by two infectious disease (ID) pharmacists and one ID physician, to evaluate respondents’: (i) demographics; (ii) self-reported practice of reviewing appropriateness of antimicrobial orders after the initial prescription (MCQ with optional free-text comments box); (iii) self-reported confidence in identifying AMS interventions during antimicrobial review (Likert-scale answers); (iv) knowledge of AMS interventions, and (iv) perceived usefulness of different modes of AMS education delivery (Likert-scale answers)
Summary
Antimicrobial stewardship (AMS) programs are usually limited in resources and scope. Wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. A core activity of the AMS team is reviewing the appropriateness of antimicrobial orders, with intervention and direct feedback to prescribers to optimize prescribing (commonly referred to as prospective audit and feedback [PAF]) [5]. Common AMS interventions identified through review of antimicrobial prescribing include narrowing the spectrum of antimicrobial activity based on microbiology tests, discontinuing antimicrobials when no longer needed, intravenous-to-oral antimicrobial switch, and dose optimization [6]. Wider engagement of frontline healthcare providers not directly involved in AMS programs, including hospital pharmacists, is necessary to ensure optimal use of antimicrobials, especially those agents not routinely reviewed by AMS teams [7]
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