Barriers in implementing antibiotic stewardship programmes at paediatric units in academic hospitals in Thailand: a qualitative study.

Objective: To explore the barriers that hinder and the facilitators that strengthen the implementation of the antimicrobial stewardship (AMS) programme at paediatric units in academic hospitals in Thailand.

Design: A qualitative study using thematic analysis of interviews with healthcare staff.

Setting: Five paediatric units in academic hospitals in Thailand.

Participants: 20 healthcare workers and 10 AMS service providers who actively participated in the AMS programme in the sampled hospitals were included from purposive criterion.

Primary outcome measures: Qualitative, interpretive description with semistructured individual interviews were digitally recorded and transcribed. The MAXQDA software was used to facilitate content analysis.

Results: In total, 4 themes emerged from the data: (1) organisational hierarchical culture and individual behaviours influence the acceptance and adherence to AMS implementation, (2) changing healthcare workers' mindset to improve stewardship is crucial, (3) effective communication and collaboration among healthcare teams are the key to implementing the AMS programme and (4) dedication to antimicrobial stewardship despite resource limitations is important to improve AMS programme implementation.

Conclusions: To implement antimicrobial stewardship in a paediatric setting, there are many issues to overcome. The key barriers to focus were organisational hierarchical culture and perception of healthcare workers. Support from hospital policy and effective communication with contextualised strategies should be considered to improve AMS programme implementation plans.