Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers. Issue 3 (November 2016)

• Record Type: Journal Article
• Authors: Broom, A.; Gibson, A.F.; Broom, J.; Kirby, E.; Yarwood, T.; Post, J.J.
• Is Part Of: Journal of hospital infection. Volume 94:Issue 3(2016)
• Page Start: 230
• Page End: 235
• Publication Date: 2016-11
• Subjects: Antimicrobial resistance -- Antimicrobial stewardship -- Hospital management -- Qualitative research; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2016.08.021
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: Antibiotic optimization in hospitals is an increasingly critical priority in the context of proliferating resistance. Despite the emphasis on doctors, optimizing antibiotic use within hospitals requires an understanding of how different stakeholders, including non-prescribers, influence practice and practice change. Aim: This study was designed to understand Australian hospital managers' perspectives on antimicrobial resistance, managing antibiotic governance, and negotiating clinical vis-à-vis managerial priorities. Methods: Twenty-three managers in three hospitals participated in qualitative semi-structured interviews in Australia in 2014 and 2015. Data were systematically coded and thematically analysed. Findings: The findings demonstrate, from a managerial perspective: (1) competing demands that can hinder the prioritization of antibiotic governance; (2) ineffectiveness of audit and monitoring methods that limit rationalization for change; (3) limited clinical education and feedback to doctors; and (4) management-directed change processes are constrained by the perceived absence of a 'culture of accountability' for antimicrobial use amongst doctors. Conclusion: Hospital managers report considerable structural and interprofessional challenges to actualizing antibiotic optimization and governance. These challenges place optimization as a lower priority vis-à-vis other issues that management are confronted with in hospital settings, and emphasize the importance of antimicrobial stewardship (AMS) programmes that engage management in understanding and addressing the barriers to change.