Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study.

The overuse of antimicrobials in primary care can be linked to an increased risk of antimicrobial-resistant bacteria for individual patients. Although there are promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs) in hospitals and long-term care settings, there is limited knowledge in primary care settings and how to implement ASPs in these settings is unclear. In this context, a qualitative study was undertaken to explore the perceptions of primary care prescribers of the usefulness, feasibility, and experiences associated with the implementation of a pilot community-focused ASP intervention in three primary care clinics. Qualitative interviews were conducted with primary care clinicians, including local ASP champions, prescribers, and other primary health care team members, while they participated in an ASP initiative within one of three primary care clinics. An iterative conventional content analyses approach was used to analyze the transcribed interviews. Themes emerged around the key enablers and barriers associated with ASP implementation. Study findings point to key insights relevant to the scalability of community ASP activities with primary care providers.

Engaging Nurses in Optimizing Antimicrobial Use in ICUs: A Qualitative Study.

Antimicrobial stewardship programs (ASPs) have predominately involved infectious diseases physicians and pharmacists with little attention to the nurses. To achieve optimal success of ASPs, engagement of nurses to actively participate in initiatives, strategies, and solutions to combat antibiotic resistance across the health care spectrum is required. In this context, the experiences of local ASP teams engaging nurses in appropriate antimicrobial use were explored to inform future strategies to enhance their involvement in ASPs.

Collaborative Care Transitions Symposium: Insights from Participants.

BACKGROUND/PURPOSE: There are promising signs that interprofessional collaborative practice is associated with quality care transitions and improved access to patient-centred healthcare. A one-day symposium was held to increase awareness and capacity to deliver quality collaborative care transitions to interprofessional health disciplines and service users. METHOD: A mixed methods study was used that included a pre-post survey design and interviews to examine the impact of the symposium on knowledge, attitudes and practice change towards care transitions and collaborative practice with symposium participants. DISCUSSION: Our survey results revealed a statistically significant increase in only a few of the scores towards care transitions and collaborative practice among post-survey respondents. Three key themes emerged from the qualitative analysis, including: (1) engaging the patient at the heart of interprofessional collaboration and co-design of care transitions; (2) having time to reach out, share and learn from each other; and (3) reflecting, reinforcing and revising practice. CONCLUSION: Further efforts that engage inter-organizational learning by exchanging knowledge and evaluating these forums are warranted.

The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital.

Antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. Antimicrobial stewardship programs (ASP) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including Clostridium difficile infection (CDI) and the emergence of resistant organisms. Antimicrobial Stewardship involves a coordinated set of interventions that ensure patients who require antimicrobial therapy receive the most appropriate agent at the correct dose, by the correct route for the correct duration. This project focused on the appropriate conversion from intravenous (IV) to oral (PO) antibiotics. The purpose of the project was to determine whether antibiotic prescribing patterns improved following the implementation of an IV to PO conversion clinical intervention form. A collaborative approach was used by an interprofessional team to review medical records and design a clinical intervention form that adheres to evidence-based guidelines to promote appropriate conversion for patients on intravenous antibiotics. Education efforts were made to inform health system staff about the goal of the intervention and to gather feedback for the improvement of the clinical intervention form. A five-week pilot intervention period trial was carried out with a specific focus on the fluoroquinolone class of antibiotics, specifically ciprofloxacin, moxifloxacin, and levofloxacin. Data from the intervention phase, including overall antibiotic use, ratio of intravenous:oral antibiotic time and compliance with the clinical intervention form were assessed. The ratio of intravenous to oral fluoroquinolone use changed from 39.4% IV: 60.6% PO before the intervention, to 34.7% IV: 65.3% PO during the intervention, indicating an overall increase in the usage of oral fluoroquinolones during the intervention phase. In patients eligible to receive the clinical intervention form, physician compliance with the form was 50%. IV duration decreased by 42% in patients with physician compliance. Further refinement of this form and the process for implementation will further enhance the conversion of intravenous to oral therapy. Based on these findings and the lessons learned, this process will be considered for further refinements, spread, and sustainability.