The protected antimicrobial process in a University Teaching Hospital: a qualitative interview study exploring the knowledge, attitudes, and experiences of healthcare professionals

E Burton,A Fleming,M O’Driscoll

doi:10.1007/s11096-022-01381-z

Abstract

Background The protected or restricted supply of certain antimicrobials such as linezolid, caspofungin, aztreonam, in the acute hospital setting is an important element of Antimicrobial Stewardship (AMS) programmes to address the growing problem of antimicrobial resistance. This process involves submitting an application for use to be reviewed typically by a Consultant Microbiologist, Infectious Disease Consultant or Antimicrobial Pharmacist. Aim To investigate healthcare professionals’ knowledge, experiences, and attitudes towards the protected/restricted antimicrobials process in order to identify possible methods of optimisation and improvement. Method Semi-structured interviews with stakeholders involved in the protected/restricted antimicrobial prescribing, dispensing and administration process were conducted in September–October 2019 in a 350-bed voluntary, general, acute hospital in Ireland. Interviews were analysed by the Framework method and mapped to the Theoretical Domains Framework (TDF). Results Interviews were conducted with 8 Doctors, 4 Pharmacists and 3 Nurses. TDF domains identified included: ‘Knowledge’; ‘Social/professional role and identity’; ‘Social influences’; ‘Memory, attention and decision processes’; ‘Beliefs about consequences’; ‘Environmental contexts and resources’. The relationship between prescribers and the AMS Team was reported as a facilitator of the process, whereas the inconsistency of the filing and versions of forms on the wards were seen as challenges. Conclusion The results of this study have shown that the existing protected/restricted antimicrobial process is a multi-disciplinary effort with barriers that require attention in order to make future improvements. Standardization of the form across all wards, an electronic version of the form, and structured education around AMS were suggested to optimize the process.

Highlights

Antimicrobial restriction or protection is an important and potential high impact Antimicrobial Stewardship (AMS) intervention in the hospital setting [1]
Healthcare professionals practicing in the study site are aware of the protected/restricted antimicrobial process, the principals of antimicrobial stewardship that underpin it, and its benefits to patient care
Continued education, audit and feedback of the protected/ restricted antimicrobial process with hospital healthcare professionals in the study site is essential to reinforce the impact of this Antimicrobial Stewardship (AMS) strategy

Summary

Introduction

Antimicrobial restriction or protection is an important and potential high impact Antimicrobial Stewardship (AMS) intervention in the hospital setting [1]. Formulary restriction/protection curtails the overuse of broad spectrum, costly and new antimicrobials [1, 2] It establishes the requirement for local approval from an Infectious Disease physician, microbiologist, or other member of the AMS Team to sanction those antimicrobials [2]. The protected or restricted supply of certain antimicrobials such as linezolid, caspofungin, aztreonam, in the acute hospital setting is an important element of Antimicrobial Stewardship (AMS) programmes to address the growing problem of antimicrobial resistance. This process involves submitting an application for use to be reviewed typically by a Consultant Microbiologist, Infectious Disease Consultant or Antimicrobial Pharmacist. The relationship between prescribers and the AMS Team was reported as a facilitator of the process, whereas the inconsistency of the filing and versions of forms on the wards were seen as challenges

Methods

Discussion

Conclusion