Lessons Learned from a National Hospital Antibiotic Stewardship Implementation Project

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES
Sara E. Cosgrove MD, MS (is Professor of Medicine, Johns Hopkins University School of Medicine, and Director, Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore.), Roy Ahn ScM, ScD (is Vice President, Public Health, NORC at the University of Chicago.), Prashila Dullabh MD (is Vice President and Senior Fellow, Health Sciences, and Director, Health Implementation Science Center, NORC at the University of Chicago.), Janna Gordon PhD (is Research Scientist, Health Sciences, NORC at the University of Chicago.), Melissa A. Miller MD, MS (is Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.), Pranita D. Tamma MD, MHS (is Associate Professor of Pediatrics, Johns Hopkins University School of Medicine. Please address correspondence to Pranita D. Tamma)
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引用次数: 0

Abstract

Background

The goal of antibiotic stewardship programs (ASPs) is to ensure that patients receive effective therapy while minimizing adverse events. To overcome barriers commonly faced in implementing successful ASPs, the Agency for Healthcare Research and Quality (AHRQ) established a multifaceted, nationwide Safety Program for Improving Antibiotic Use in 2018. This report summarizes the lessons learned from the implementation of this initiative based on structured interviews of personnel from participating sites.

Methods

At the completion of the one-year initiative, semistructured exit interviews were conducted with site leaders at 151 of the 402 hospitals that participated. These interviews consisted of open-ended questions about the perceived effectiveness of components of the Safety Program. Qualitative analyses incorporated both deductive coding themes (based on existing literature) and an iteratively developed inductive coding framework (based on salient themes that emerged from a subset of interviews).

Results

Several components of the Safety Program were identified as effective in expanding local stewardship activities, including techniques and strategies to implement sustainable ASPs, access to Implementation Advisors to keep sites engaged, provision of local benchmarked antibiotic use data to compare to similar hospitals, and Safety Program materials such as the antibiotic time-out tool to integrate stewardship techniques into daily work flows. The biggest challenges to greater effectiveness were suboptimal frontline staff engagement and difficulty changing antibiotic prescribing culture. Some approaches used to overcome these barriers (peer-to-peer communication and education through team huddles, identifying physician champions, informal rounds to enhance collegiality and buy-in, and engagement of hospital leadership) were identified.

Conclusion

Lessons learned from the Safety Program can be applied by other teams looking to promote an effective ASP at their hospital or system. The themes that emerged in this study likely also have relevance across a wide range of large-scale quality improvement initiatives.

从全国医院抗生素管理实施项目中汲取的经验教训
背景抗生素监管计划(ASP)的目标是确保患者接受有效治疗,同时最大限度地减少不良事件。为了克服在成功实施 ASPs 过程中普遍面临的障碍,美国医疗保健研究与质量局(AHRQ)于 2018 年在全国范围内建立了一个多方面的 "改善抗生素使用安全计划"。方法在为期一年的计划结束时,对参与计划的 402 家医院中 151 家医院的负责人进行了半结构化离职访谈。这些访谈由开放式问题组成,内容涉及对安全计划各组成部分有效性的看法。定性分析既包括演绎编码主题(基于现有文献),也包括迭代开发的归纳编码框架(基于访谈子集中出现的突出主题)。结果安全计划的几个组成部分被认为能有效扩大当地的监管活动,包括实施可持续 ASP 的技术和策略、获得实施顾问的帮助以保持医疗机构的参与度、提供当地抗生素使用基准数据以与同类医院进行比较,以及安全计划材料(如抗生素超时工具)以将监管技术整合到日常工作流程中。要想取得更大成效,最大的挑战在于一线员工的参与度不够理想,以及改变抗生素处方文化存在困难。研究发现了一些用于克服这些障碍的方法(通过团队会议进行对等交流和教育、确定医生标兵、非正式查房以加强同事间的合作和认同感以及医院领导层的参与)。本研究中出现的主题可能也适用于各种大规模的质量改进计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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