Summary
Background
The World Health Organization has identified antimicrobial resistance (AMR) as one
of the most significant global risks facing modern medicine. Interventions to improve
antibiotic prescribing have so far had limited impact.
Aim
To understand the barriers to effective antibiotic prescribing.
Methods
Mixed methodologies were used to investigate prescribing behaviours to identify the
critical points in the antibiotic prescribing pathway for hospital inpatients. We
assessed knowledge, experience or empowerment of prescribers, organizational factors,
and use of the laboratory. Phase 1 was an online survey to map barriers and facilitators
to antibiotic prescribing (56 participants). Phase 2 consisted of focus groups and
interviews to gain more understanding of prescribing behaviours (10 participants).
Phase 3 was an online survey to obtain opinions on possible solutions (22 participants).
Findings
Barriers to prescribing were: laboratory factors 71.6%, resource issues 40%, time
constraints 17.5%, pressure from others 52%. Ninety-three percent of prescribers were
concerned about AMR. In three scenarios only 9% were confident not to prescribe antibiotics
for a patient without bacterial infection; 53% would prescribe unnecessarily broad-spectrum
antibiotics for pneumonia. Only 5% would de-escalate antibiotics in a microbiologically
confirmed bacteraemia. Despite concerns about AMR, prescribers did not perceive that
continuing antibiotics for individual patients might promote resistance. Prescribers
were unwilling to change antibiotics out of hours and reported that they preferred
professional support for antibiotic prescribing.
Conclusion
There was a marked disparity between prescribers, self-reporting of prescribing behaviour
and responses to clinical scenarios. It was not clear whether training alone would
change behaviours. Prescribers desired a directive mechanism to support antibiotic
prescribing and stewardship.
Keywords
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References
- Global action plan on antimicrobial resistance.WHO Press, Geneva2015
- Start smart – then focus. Antimicrobial stewardship toolkit for English hospitals.PHE, London2011 (updated March 2015)
Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. Available at: https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html [last accessed July 2018].
- English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2017.PHE, London2017
- Variability in antibiotic use at children's hospitals.Pediatrics. 2010; 126: 1067-1073
- Qualitative interview study of parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care.BMJ Open. 2017; 7e015701
- Behaviour change and antibiotic prescribing in healthcare settings. Literature review and behavioural analysis.DH, London2013
- Role of antimicrobial stewardship programmes in children: a systematic review.J Hosp Infect. 2018; 99: 117-123
- Miles to go: an introduction to the 5 million lives campaign.Jt Comm J Qual Patient Saf. 2007; 33: 477-484
- UK five year antimicrobial resistance strategy 2013 to 2018.DH, London2013
- Educating healthcare professionals in antimicrobial stewardship: can online-learning solutions help?.J Antimicrob Chemother. 2015; 70: 3175-3177
- The expanding role of antimicrobial stewardship programs in hospitals in the United States: lessons learned from a multisite qualitative study.Jt Comm J Qual Patient Saf. 2018; 44: 68-74
- A review of antimicrobial stewardship training in medical education.Int J Med Educ. 2017; 8: 353-374
Department of Health. Health and social care act 2008. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/449049/Code_of_practice_280715_acc.pdf [last accessed July 2018].
- Essential resources and strategies for antibiotic stewardship programs in the acute care setting.Clin Infect Dis. 2018 Mar 26; ([Epub ahead of print])https://doi.org/10.1093/cid/ciy255
- E-learning for health professionals.Cochrane Database Syst Rev. 2018; 1CD011736
Article info
Publication history
Published online: July 30, 2018
Accepted:
July 25,
2018
Received:
June 18,
2018
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Ltd on behalf of The Healthcare Infection Society. All rights reserved.
