Antimicrobial stewardship in regional hospitals: a human factors evaluation of barriers and facilitators and the role of technology.

Abstract

Background: Antimicrobial stewardship (AMS) programmes aim to optimise antimicrobial prescribing. Regional hospitals have reduced access to resources that are essential for conducting AMS initiatives. Technology has the potential to reduce these challenges if implemented and used effectively.

Objective: Identify the barriers and facilitators to successful AMS programmes in two regional hospitals in Australia and explore the role technology played in supporting AMS.

Methods: A contextual inquiry methodological approach was used, including observations and semi-structured interviews with AMS team members in two regional hospitals in Australia.

Results: Observations were conducted for 27.5 h and interviews were performed with all AMS team members (n = 4). Electronic medication management and an antimicrobial dashboard were reported to make AMS processes efficient and information accessible. The use of multiple computerised systems and poor interoperability hindered AMS work processes. Executive support, resourcing and building rapport through in-person interactions were reported to influence the success of AMS programmes. Passionate and motivated infectious diseases (ID) consultants drove AMS programmes by building rapport with stakeholders and advocating for resources. COVID-19 was viewed as a facilitator of AMS as it increased the visibility of ID consultants, resulting in improved relationships and additional resources.

Conclusions: Using a small number of interoperable systems can enhance AMS, with tools such as an antimicrobial dashboard proving beneficial for remotely accessing information and reviewing antimicrobials in peripheral hospitals. Essential components for effective AMS programmes include supportive hospital executives and adequate staff resources. Sustaining AMS in regional settings relies on committed ID doctors and strong interdepartmental relationships.