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Henley J, Brookes-Howell L, Euden J, Pallmann P, Llewelyn M, Howard P, Powell N, Dark P, Szakmany T, Hellyer TP, Albur M, Hamilton R, Prestwich G, Ogden M, Maboshe W, Sandoe J, Thomas-Jones E, Carrol E. Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study). BMJ Open 2023; 13:e077117. [PMID: 38114276 DOI: 10.1136/bmjopen-2023-077117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic. DESIGN Semistructured qualitative interview study. SETTING National Health Service (NHS) trusts/health boards in England and Wales. PARTICIPANTS Clinicians from NHS trusts/health boards in England and Wales. METHOD Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions. RESULTS During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed. CONCLUSION This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic. TRIAL REGISTRATION NUMBER ISRCTN66682918.
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Affiliation(s)
- Josie Henley
- School of Social Sciences, Cardiff University, Cardiff, UK
| | | | - Joanne Euden
- College of Biomedical and Life Sciences, Cardiff University Centre for Trials Research, Cardiff, UK
| | - Philip Pallmann
- College of Biomedical and Life Sciences, Cardiff University Centre for Trials Research, Cardiff, UK
| | - Martin Llewelyn
- Brighton and Sussex Medical School, University of Sussex and University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Philip Howard
- School of Healthcare, University of Leeds, Leeds, UK
- Pharmacy, Leeds Teaching Hospitals, Leeds, UK
| | - Neil Powell
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Paul Dark
- Intensive Care Unit, University of Manchester, Salford, UK
| | - Tamas Szakmany
- Critical Care Directorate, Aneurin Bevan University Health Board, Newport, UK
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff Univeristy, Cardiff, UK
| | - Thomas P Hellyer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ryan Hamilton
- School of Pharmacy, De Montfort University, Leicester, UK
| | | | - Margaret Ogden
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Jonathan Sandoe
- Department of Microbiology, The General Infirmary at Leeds, Leeds, UK
- Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - Enitan Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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