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Strahilevitz J, Oreg S, Nir Paz R, Sagiv L. Nurses' and Physicians' Responses to a New Active Antimicrobial Stewardship Program: A Two-Phase Study of Responses and Their Underlying Perceptions and Values. Int J Health Policy Manag 2022; 11:2982-2989. [PMID: 35596273 PMCID: PMC10105176 DOI: 10.34172/ijhpm.2022.6557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 05/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Successful implementation of an antimicrobial stewardship program (ASP) depends on staff members' response to it. We introduced at the Hadassah Medical Center in Israel a significant change to our long-standing handshake ASP. As before, the new ASP involved a dialogue between the treating physician and the infectious disease physician over the appropriate antibiotic therapy. The main change was that the infectious disease physician's decision was now integrated into the patient's electronic medical record (EMR). Our purpose in this study was to uncover the concerns and expectations of physicians and nurses towards the new ASP, before and after its implementation, and link these with their basic perceptions of the ASP and their personal values. METHODS We used open-ended questions and Likert-type scales to study staff members' personal values, basic perceptions of the new system, and attitudes towards it, both before (N = 143), and one year after (N = 103) the system's implementation. Relationships of the system's perceptions and personal values with attitudes toward the system were tested using correlations and multiple regression analyses. RESULTS Prior to its implementation, physicians and nurses had multiple concerns about the new ASP's demandingness and inefficiency and its threat to physicians' autonomy and expertise. They also had positive expectations for benefits to the hospital, the patients and society. A year later, following the system's implementation, concerns dissipated, whereas the perceived benefits remained. Moreover, staff members' attitudes tended to be more positive among those who value conformity. CONCLUSION Introducing new ASPs is a challenging process. Our findings suggest that hospital staff's initial concerns about the new ASP were primarily about its ease of use and demandingness. These concerns, which diminished over time, were linked with perceived satisfaction with the system. Conformity values had an indirect effect in predicting satisfaction with the system, mediated by perceptions of the system as straightforward.
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Affiliation(s)
- Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Shaul Oreg
- School of Business Administration, The Hebrew University, Jerusalem, Israel
| | - Ran Nir Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Lilach Sagiv
- School of Business Administration, The Hebrew University, Jerusalem, Israel
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Wimmer MR, Schulz LT, Hamel AG, Schwei RJ, Fong K, Burgess DR, Brett M, Hale CM, Holubar M, Jain R, Larry R, Spivak ES, Newland H, Njoku J, Postelnick M, Walraven C, Pulia MS. The impact of coronavirus disease 2019 (COVID-19) on the antimicrobial stewardship pharmacist workforce: A multicenter survey. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e56. [PMID: 36483364 PMCID: PMC9726570 DOI: 10.1017/ash.2022.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems and hospitals to rapidly modify standard practice, including antimicrobial stewardship services. Our study examines the impact of COVID-19 on the antimicrobial stewardship pharmacist. DESIGN A survey was distributed nationally to all healthcare improvement company members. PARTICIPANTS Pharmacist participants were mostly leaders of antimicrobial stewardship programs distributed evenly across the United States and representing urban, suburban, and rural health-system practice sites. RESULTS Participants reported relative increases in time spent completing tasks related to medication access and preauthorization (300%; P = .018) and administrative meeting time (34%; P = .067) during the COVID-19 pandemic compared to before the pandemic. Time spent rounding, making interventions, performing pharmacokinetic services, and medication reconciliation decreased. CONCLUSION A shift away from clinical activities may negatively affect the utilization of antimicrobials.
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Affiliation(s)
- Megan R. Wimmer
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Lucas T. Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Ashlee G. Hamel
- Department of Pharmacy, Sentara Healthcare, Norfolk, Virginia
| | - Rebecca J. Schwei
- Department of Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin
| | - Karen Fong
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah
| | | | - Meghan Brett
- University of New Mexico Hospital, Albuquerque, New Mexico
| | - Cory M. Hale
- Department of Pharmacy, Penn State Health Milton S. Hershey Medical Center, HersheyPennsylvania
| | - Marisa Holubar
- Stanford University School of Medicine, Stanford, California
| | - Rupali Jain
- University of Washington, Seattle, Washington
| | - Rachel Larry
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | | | | | | | - Michael Postelnick
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - Carla Walraven
- University of New Mexico Hospital, Albuquerque, New Mexico
| | - Michael S. Pulia
- Department of Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin
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Kimbowa IM, Eriksen J, Nakafeero M, Obua C, Lundborg CS, Kalyango J, Ocan M. Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda. PLoS One 2022; 17:e0262993. [PMID: 35113932 PMCID: PMC8812957 DOI: 10.1371/journal.pone.0262993] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Though antimicrobial stewardship (AMS) programmes are the cornerstone of Uganda's national action plan (NAP) on antimicrobial resistance, there is limited evidence on AMS attitude and practices among healthcare providers in health facilities in Uganda. We determined healthcare providers' AMS attitudes, practices, and associated factors in selected health facilities in Uganda. We conducted a cross-sectional study among nurses, clinical officers, pharmacy technicians, medical officers, pharmacists, and medical specialists in 32 selected health facilities in Uganda. Data were collected once from each healthcare provider in the period from October 2019 to February 2020. Data were collected using an interview-administered questionnaire. AMS attitude and practice were analysed using descriptive statistics, where scores of AMS attitude and practices for healthcare providers were classified into high, fair, and low using a modified Blooms categorisation. Associations of AMS attitude and practice scores were determined using ordinal logistic regression. This study reported estimates of AMS attitude and practices, and odds ratios with 95% confidence intervals were reported. We adjusted for clustering at the health facility level using clustered robust standard errors. A total of 582 healthcare providers in 32 healthcare facilities were recruited into the study. More than half of the respondents (58%,340/582) had a high AMS attitude. Being a female (aOR: 0.66, 95% CI: 0.47-0.92, P < 0.016), having a bachelor's degree (aOR: 1.81, 95% CI: 1.24-2.63, P < 0.002) or master's (aOR: 2.06, 95% CI: 1.13-3.75, P < 0.018) were significant predictors of high AMS attitude. Most (46%, 261/582) healthcare providers had fair AMS practices. Healthcare providers in the western region's health facilities were less likely to have a high AMS practice (aOR: 0.52, 95% CI 0.34-0.79, P < 0.002). In this study, most healthcare providers in health facilities had a high AMS attitude and fair AMS practice.
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Affiliation(s)
- Isaac Magulu Kimbowa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Unit of Infectious diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mary Nakafeero
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joan Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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Sato SA, Brandão DA, Madalosso G, Levin AS, Perdigão LV, Oliveira MS. Current Status of Antimicrobial Stewardship Programs in São Paulo Hospitals. Clinics (Sao Paulo) 2021; 76:e2882. [PMID: 34190852 PMCID: PMC8221563 DOI: 10.6061/clinics/2021/e2882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship programs (ASPs) comprise coordinated interventions designed to improve antimicrobial use. Understanding the current structure of ASP hospitals will support interventions for the improvement of these programs. This study aimed to describe the status of ASPs in hospitals in São Paulo, Brazil. METHODS A cross-sectional survey was conducted on the ASPs of hospitals in the state of São Paulo from March to July 2018. Through interviews by telephone or e-mail, we queried which components of the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and Centers for Disease Control and Prevention guidelines were implemented. RESULTS The response rate was 30% (28/93 hospitals), and 26 hospitals (85%) reported having a formal ASP. The most frequently implemented strategies were antimicrobial surgical prophylaxis guidelines (100%), empiric sepsis guidelines (93%), and the presence of ASP team members during bedside rounds (96%). The least commonly implemented strategies included prior authorization for all antimicrobials (11%), pharmacokinetic monitoring, and an adjustment program for patients on IV aminoglycosides (3%). Regarding the metrics of the ASP, the most common indicator was the rate of antimicrobial resistance (77%). Eighteen hospitals evaluated antimicrobial consumption using defined daily dose, and only 29% evaluated the days of therapy; 61% of hospitals reported their results to the hospital administration and 39% to the prescribers. CONCLUSIONS Most hospitals have a formal and active ASP, but with timely actions. We observed inconsistencies between what program leaders understand as the main objective of ASP and the metrics used to evaluate it. Part of the effort for the next few years should be to improve program evaluation metrics and to provide feedback to physicians and hospital leadership.
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Affiliation(s)
- Silvia Akemi Sato
- Departamento de Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Denise Assis Brandão
- Divisao de Infeccoes Hospitalares, Centro de Vigilancia Epidemiologica ”Prof. Alexandre Vranjac” Centro de Controle de Doencas, Secretaria de Estado da Saude, Sao Paulo, SP, BR
| | - Geraldine Madalosso
- Divisao de Infeccoes Hospitalares, Centro de Vigilancia Epidemiologica ”Prof. Alexandre Vranjac” Centro de Controle de Doencas, Secretaria de Estado da Saude, Sao Paulo, SP, BR
| | - Anna S. Levin
- Departamento de Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Doencas Infecciosas, Laboratorio de Investigacao Medica (LIM 54) e Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Lauro Vieira Perdigão
- Departamento de Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maura Salaroli Oliveira
- Departamento de Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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