Duration of antibiotic therapy in the intensive care unit: factors influencing decision-making during multidisciplinary meetings.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Robin M E Janssen, Anke J M Oerlemans, Nynke Bos, Johannes G van der Hoeven, Evelien A N Oostdijk, Lennie P G Derde, Jaap Ten Oever, Heiman F L Wertheim, Jeroen A Schouten, Marlies E J L Hulscher
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引用次数: 0

Abstract

Objectives: In the intensive care unit (ICU), antibiotics are often given longer than recommended in guidelines. A better understanding of the factors influencing antibiotic therapy duration is needed to develop improvement strategies to effectively address these drivers of excessive duration. This study aimed to explore the determinants of adherence to recommended antibiotic therapy durations among healthcare professionals involved in antibiotic decision-making within the ICU, focusing on multidisciplinary meetings (MDMs).

Methods: Semistructured interviews were held with healthcare professionals involved in antibiotic decision-making during MDMs in four Dutch ICUs. Participants included intensivists, clinical microbiologists and ICU residents. Transcripts were analysed using deductive and inductive content analysis methods.

Results: A total of 20 participants were interviewed. The interviews revealed that decision-making regarding antibiotic therapy duration is a complex process, primarily centred around professional interactions during MDMs and involving a broad range of determinants. These determinants were categorised into the following four steps: (1) the introduction of duration as a topic for discussion in the MDM (eg, lack of priority to discuss antibiotic therapy duration); (2) the discussion of antibiotic therapy duration itself (eg, lack of core members during MDM); (3) the establishment of a concrete decision (eg, lack of documentation of the decisions made); (4) the execution of the decision (eg, forgetting to stop antibiotics).

Conclusions: Our study identified numerous factors that influence decisions about the duration of antibiotic therapy during MDMs in the ICU. By describing these factors throughout the decision-making process, we provided valuable insights into barriers that commonly arise in specific steps, highlighting critical areas for improvement. Daily MDMs were deemed essential for informed decision-making regarding antibiotic therapy duration by the interviewees. Strategies to improve appropriate duration in the ICU should prioritise strengthening interdisciplinary communication between healthcare professionals and adding structure to these meetings.

重症监护室抗生素治疗的持续时间:影响多学科会议决策的因素。
目的:在重症监护病房(ICU),抗生素的使用时间往往比指南推荐的时间长。需要更好地了解影响抗生素治疗持续时间的因素,以制定改进策略,有效地解决这些持续时间过长的驱动因素。本研究旨在探讨ICU内参与抗生素决策的医疗保健专业人员坚持推荐抗生素治疗持续时间的决定因素,重点是多学科会议(MDMs)。方法:对荷兰四家icu在mdm期间参与抗生素决策的医疗保健专业人员进行半结构化访谈。参与者包括重症医师、临床微生物学家和ICU住院医师。采用演绎和归纳的内容分析方法对转录本进行分析。结果:共访谈20名参与者。访谈显示,关于抗生素治疗持续时间的决策是一个复杂的过程,主要围绕mdm期间的专业互动,涉及广泛的决定因素。这些决定因素分为以下四个步骤:(1)在MDM中引入持续时间作为讨论的主题(例如,没有优先讨论抗生素治疗持续时间);(2)抗生素疗程本身的讨论(如MDM过程中核心成员的缺失);(3)确定具体的决定(例如,缺乏所作决定的文件);(4)决定的执行(例如,忘记停用抗生素)。结论:我们的研究确定了许多影响ICU MDMs期间抗生素治疗持续时间的因素。通过在整个决策过程中描述这些因素,我们对具体步骤中通常出现的障碍提供了有价值的见解,突出了需要改进的关键领域。受访者认为每日MDMs对于抗生素治疗持续时间的知情决策至关重要。改善ICU适当住院时间的策略应优先考虑加强医疗专业人员之间的跨学科沟通,并增加这些会议的结构。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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