Development of a pilot interprofessional education workshop for healthcare students and assessment of interprofessional collaborative competency attainment.

We describe the development and student evaluation of a collaborative health service provider and higher education institution initiative designed to deliver an Interprofessional Education (IPE) pilot workshop program for healthcare students. The aim was to investigate whether an IPE workshop would result in improved student confidence in self-reported interprofessional competencies using the Interprofessional Collaborative Competency Attainment Scale (ICCAS) tool. The workshops involved interprofessional student groups working on a patient case followed by a facilitator-led discussion and patient representative interaction. There were three different voluntary, extra-curricular workshops. A total of 99 students registered, from 3rd to 5th year undergraduate and 2nd year graduate entry healthcare programs at a single Irish university in February 2022. Ninety-three post-workshop survey responses showed statistically significant improvements in the ICCAS subscales of Communication, Collaboration, Roles and Responsibilities, Collaborative Patient/Family-Centered Approach, and Team Functioning; Conflict Management showed less change. Students reported positively on the benefit of the patient representative, the workshop format, and the opportunity to collaborate with students from other professions. Our findings indicate that this was a beneficial and effective way to deliver IPE across a range of healthcare professions that led to improvements in self-reported interprofessional competencies.

Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults.

AIMS: Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. METHODS: Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. RESULTS: Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication-recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity-the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships-personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment-organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. CONCLUSION: This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults.

Medication reconciliation: time to save? A cross-sectional study from one acute hospital.

PURPOSE: Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance. METHODS: A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated. RESULTS: Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8-1.9 million. CONCLUSIONS: Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.

GPs' perspectives on prescribing for older people in primary care: a qualitative study.

AIMS: The aim of this study was firstly to reveal the determinants of GP prescribing behaviour for older adults in primary care and secondly to elicit GPs' views on the potential role for broad intervention strategies involving pharmacists and/or information technology systems in general practice. METHODS: Semi-structured qualitative interviews were carried out with a purposive sample of GPs. Three multidisciplinary researchers independently coded the interview data using a framework approach. Emerging themes were mapped to the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories. RESULTS: Sixteen GPs participated in the study. The following domains in the TDF were identified as being important determinants of GP prescribing behaviour: 'Knowledge', 'Skills', 'Reinforcement', 'Memory Attention and Decision Process', 'Environmental Context and Resources', 'Social Influences', 'Social/Professional Role and Identity'. Participants reported that the challenges associated with prescribing for an increasingly older population will require them to become more knowledgeable in pharmacology and drug interactions and they called for extra training in these topics. GPs viewed strategies such as academic detailing sessions delivered by pharmacists or information technology systems as having a positive role to play in optimizing prescribing. CONCLUSION: This study highlights the complexities of behavioural determinants of prescribing for older people in primary care and the need for additional supports to optimize prescribing for this growing cohort of patients. Interventions that incorporate, but are not limited to interprofessional collaboration with pharmacists and information technology systems, were identified by GPs as being potentially useful for improving prescribing behaviour, and therefore require further exploration.

Antimicrobial susceptibility of long term care facility and general practice urine samples in patients 65 years and older: an observational study.

Background: Antimicrobial resistance in long-term care facilities (LTCFs) poses a risk to elderly residents. The aim of this observational study was to investigate recent patterns of antimicrobial susceptibility in urine samples submitted to the Microbiology Laboratory at Cork University Hospital (CUH) from LTCFs in the greater Cork region. The antimicrobial susceptibilities of LTCF and General Practitioner (GP) urine samples sent to CUH, for patients aged over 65 years of age, were compared. Methods: A retrospective analysis of the antimicrobial susceptibilities of urine samples submitted to the microbiology laboratory at CUH in quarter one of 2011-2014 was conducted. LTCF and GP urine sample susceptibilities, for patients over 65 years of age, were compared using Chi square statistics. Results: Overall, the LTCF urine samples were less susceptible than GP urine samples to the antimicrobials recommended in the national urinary tract infection guidelines; trimethoprim, nitrofurantoin, cephalexin, co-amoxiclav, ciprofloxacin and amoxicillin ( P < 0.001). Important trends in antimicrobial susceptibility over the time period were noted. A significant reduction in susceptibility to co-amoxiclav was found between Q1 2011 and Q1 2014 in both settings (GP P = 0.013, LTCF P = 0.005). This study provides important information which will contribute to the revision of antimicrobial prescribing guidelines in the future. Conclusion: This study highlights the need for continuous surveillance of antimicrobial susceptibility trends in LTCFs. Antimicrobial stewardship strategies are urgently required to address antimicrobial resistance and appropriate antimicrobial prescribing in the LTCF setting.

Doctors' perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study.

AIMS: Older patients commonly suffer from multimorbidites and take multiple medications. As a result, these patients are more vulnerable to potentially inappropriate prescribing (PIP). PIP in older patients may result in adverse drug events (ADEs) and hospitalizations. However, little has been done to identify why PIP occurs. The objectives of this study were (i) to identify hospital doctors' perceptions as to why PIP occurs, (ii) to identify the barriers to addressing the issues identified and (iii) to determine which intervention types would be best suited to improving prescribing. METHODS: Semi-structured interviews based on the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories, were conducted with 22 hospital doctors. Content analysis was conducted to identify domains of the TDF that could be targeted to improve prescribing for older people. These domains were then mapped to the behaviour change wheel to identify possible intervention types. RESULTS: Content analysis identified five of the 12 domains in the TDF as relevant: (i) environmental context and resources, (ii) knowledge, (iii) skills, (iv) social influences and (v) memory/attention and decision processes. Using the behaviour change wheel, the types of interventions deemed suitable were those based on training and environmental restructuring. CONCLUSION: This study shows that doctors feel there is insufficient emphasis on geriatric pharmacotherapy in their undergraduate/postgraduate training. An intervention providing supplementary training, with particular emphasis on decision processes and dealing with social influences would be justified. This study has, however, uncovered many areas for potential intervention in the future.

Trends in antibiotic prescribing in primary care out-of-hours doctors' services in Ireland.

Background: Infections are a common reason for patient consultation in out-of-hours (OOH) doctors' services. Surveillance of antibiotic prescribing in OOH settings is important to develop tailored antimicrobial stewardship (AMS) interventions. Objectives: To evaluate antibiotic prescribing patterns in OOH services in the Cork Kerry region, Ireland to inform future AMS interventions. Methods: A retrospective, observational cohort study was conducted of all oral antibiotic prescriptions in OOH doctors' consultations between 1 December 2019 and 31 December 2021 in the region. Data were gathered on age, gender, date and time of consultation, consultation method (in person, remote), antibiotic and its indication. Data were analysed using Microsoft Excel v.2018 and SPSS v.28. Results: Overall, 17% (69 017 of 406 812) of the OOH doctors' consultations resulted in an antibiotic prescription during the study period. This varied from 31% of OOH consultations in December 2019 to less than 2% of OOH consultations in April 2020. Of the antibiotics prescribed, 21% were for children under 6 years old. Respiratory tract infections (RTIs) were the most common indication for antibiotics (59%). Amoxicillin was the most commonly prescribed antibiotic (40% of all prescriptions). Red (reserved) antibiotics accounted for 19% of all prescriptions. During the COVID-19 pandemic period of the study, 66% of 49 421 of antibiotic prescriptions were issued from remote consultations. Conclusions: Low antibiotic prescribing levels during the early stages of the pandemic were not sustained. Antibiotic prescriptions from remote consultations were common. A key opportunity for AMS is addressing the volume of antibiotic prescribing for RTIs, particularly in children.

Quality assurance standards and their use in the preparation of parenteral systemic anticancer therapy products in healthcare establishments: a scoping review.

OBJECTIVES: The use of parenteral systemic anticancer therapy (SACT) has led to improved cancer survival. A quality assurance (QA) system of the aseptic compounding process is necessary to ensure safe and consistent production of parenteral SACT. This scoping review identifies international evidence and practice relating to QA standards in the preparation of parenteral SACT in healthcare establishments. METHODS: Standards relating to aseptic compounding in hospital pharmacies and literature exploring the aseptic compounding of parenteral SACT were included. Literature relating to the non-aseptic compounding of medicines and records specific to sterile manufacturing in industrial settings were excluded. A search of several electronic databases, trial registries, the grey literature and websites of key European hospital pharmacy groups and accreditation bodies was conducted on 16 March 2022. A narrative discussion was performed by country, and content analysis of articles was conducted. RESULTS: Thirty-seven records were included. Standards reviewed covered the work environment, the preparation process and the safety of the workers who are potentially exposed to hazardous chemicals. It was a common practice to include frequent audits to ensure adherence to standards. Some standards also recommended external inspections to allow for further learnings. Periodic reviews are encouraged to ensure standards maintain relevance. National standards of the countries reviewed were based on international standards, with minor adaptations for local conditions. CONCLUSIONS: The main limitation of this review is that it is limited to countries with a high human development index. The review shows that the use of an internationally recognised standard as a basis for national standards is best practice, and will allow for relevance into the future.

Identifying intervention strategies to improve HPV vaccine decision-making using behaviour change theory.

Although the HPV vaccine is highly safe and effective, its uptake is sub-optimal in many countries, including Ireland. There is therefore a need to identify appropriate interventions that will increase HPV vaccine acceptance by parents. In this study, we took a systematic approach to understand the factors that influence HPV vaccine uptake by parents of adolescent girls in Ireland to define suitable behaviour change interventions that would support positive vaccine decision-making in the future. Specifically, we conducted semi-structured interviews, used a Theoretical Domains Framework (TDF)-based topic guide, to gain insight into the knowledge, beliefs, attitudes and current behaviours of parents with respect to their HPV vaccine decision. Transcripts were analysed using the TDF. The Behaviour Change Wheel (BCW) was used to identify relevant intervention functions and the Behaviour Change Technique Taxonomy version 1 (BCTTv1), to identify relevant intervention techniques. All parents discussed the essential role of healthcare providers in vaccine decision-making. Complacency and confidence were important factors in decision-making by vaccine hesitant parents. Five BCW intervention functions were identified as appropriate, namely; education; persuasion; environmental restructuring; modelling and enablement. To our knowledge, this is the first study to systematically evaluate HPV vaccine decision-making using behaviour change theory and identify suitable intervention strategies to promote positive vaccine decision-making using this approach.

A Video-Based Behavioral Intervention Associated with Improved HPV Knowledge and Intention to Vaccinate.

The aim of this study was to design, develop, and evaluate the feasibility of a theory- and evidence-based intervention to improve human papillomavirus (HPV) and HPV vaccine knowledge and intention to vaccinate, among parent-daughter dyads. A theory- and evidence-based online behavioral intervention, "Is the HPV vaccine for me?", was developed to improve HPV and HPV vaccine knowledge and intention to vaccinate. Knowledge, intention to vaccinate, and feasibility of the intervention were evaluated in a prospective, randomized, controlled feasibility trial. A total of 49 parent-daughter dyads completed the baseline knowledge assessment (n = 24 control, n = 25 intervention), and 35 dyads completed the knowledge assessment at week 2 (n = 17 control, n = 18 intervention). The intervention resulted in a statistically significant increase in HPV and HPV vaccine knowledge and intention to vaccinate. All intervention participants found the video interesting, while 96% found it useful. This intervention was found to be useful, effective, safe, and acceptable in this feasibility study.

Supporting pharmacy students' preparation for an entry-to-practice OSCE using video cases.

BACKGROUND AND PURPOSE: Objective structured clinical examinations (OSCEs) are widely used, including in licensure examinations. OSCEs assess diverse skills in a structured manner, but can be stressful for students and have a significant organisational burden for faculty. Case-based video OSCE preparation resources were developed for students preparing for a licensure OSCE. The study aimed to examine student engagement, compare scores awarded by students to performances at specific competence standards with faculty scores, and examine usability, usefulness, and acceptability of the video cases. EDUCATIONAL ACTIVITY AND SETTING: Final year pharmacy students (n = 149) enrolled in an integrated master of pharmacy programme in Ireland were invited to participate. Six sets of recorded OSCE-based video cases were developed, comprising multiple recordings of the same case scenario, with each pitched at a different level of performance. Students watched and scored the video cases. Usability, usefulness, and acceptability were evaluated via questionnaire. FINDINGS: One or more video cases were accessed by 70.5% of students. Score ratings awarded by the students, when compared to faculty ratings, showed an overall trend towards inter-rater agreement between students and faculty. Students felt positively in terms of the usability, usefulness, and acceptability of the videos. SUMMARY: Video cases designed to support OSCE preparation for a high-stakes national pharmacy licensure examination were widely used by students and were perceived to be usable, useful, and acceptable. Such video cases may be a feasible alternative to additional mock OSCEs to support student preparation.

A qualitative study of the views of healthcare professionals on providing vaccines information to patients.

Background Healthcare professionals (HCPs) such as pharmacists, general practitioners and practice nurses are a trusted source of vaccines information for patients in primary care. Global regulators have highlighted the key role of HCPs in fostering confidence in COVID-19 vaccines. Objective This study aims to gain insight into the views and experiences of HCPs on providing vaccines information to patients. Setting Primary care general practice surgeries and community pharmacies in Ireland. Methods Qualitative, semi-structured interviews were conducted with 14 HCPs (five General practitioners [GPs], four practice nurses and five community pharmacists) identified through purposive and convenience sampling. The interviews were analysed by inductive thematic analysis. Main outcome measure Participants' views and experiences of providing vaccines information to patients. Results Five key themes were identified: roles and responsibilities, perception of risk, perception of the public, building a relationship, and emotion. HCPs were motivated by duty and care for their patients. They respected patient autonomy and were driven by their concern for public health. HCPs were influenced by their perception of risk and their perceptions of the public. HCPs practiced patient-centred care by providing tailored vaccines information. They favoured an approach of providing patients with information and support to make their own decision. The topic was emotive; HCPs empathised with patients but were also frustrated by their perceived inability to change some patients' views. Conclusion The provision of vaccines information by HCPs to patients is multifactorial with participants mindful of patient autonomy and the HCP role to support vaccinations as a public health priority. Participants suggested that education and support on vaccines communication would enable them to support the vaccines uptake in their practice.

Parent Attitudes about Childhood Vaccines: Point Prevalence Survey of Vaccine Hesitancy in an Irish Population.

Understanding parental attitudes to their children's vaccination is critical to developing and implementing interventions that address parents' hesitancy and improve vaccine uptake. The Parent Attitudes about Childhood Vaccines (PACV) survey is a validated tool for identifying vaccine hesitancy in parents. We evaluated the rate of vaccine hesitancy and areas of concern regarding childhood vaccinations using an adapted version of the PACV survey, in a convenience sample of parents attending a STEM (Science, Technology, Engineering and Mathematics) outreach event in Ireland, in 2018. A score ≥ 50 identified vaccine hesitant parents. Of 105 parents who completed the survey, the prevalence of vaccine hesitancy was 6.7%, (7/105). Parents had concerns around vaccine side effects (36.2%, n = 38), vaccine safety (20%, n = 21) and the number of vaccines administered (13.3%, n = 14). Parents trusted the vaccine information they received (85.6%, n = 90) and 81.9% (n = 86) believed that the vaccine schedule was good for their child. The findings indicate the presence of vaccine hesitancy in parents in Ireland regarding paediatric vaccines with further research necessary to address parents' vaccine concerns. Future research should explore further, by qualitative methods, parents' vaccine concerns. There is also potential to identify vaccine hesitant parents with the PACV survey as a surveillance method in healthcare settings; for example, in community pharmacies, family doctor clinics and out-patient clinics.

Aspirin compared to enoxaparin or rivaroxaban for thromboprophylaxis following hip and knee replacement.

Background The risk of venous thromboembolism following major orthopaedic surgery is among the highest for all surgical specialties. Our hospital guidelines for thromboprophylaxis following elective primary total hip or knee replacement are based on American College of Chest Physicians guidance. The most recent change to local guidelines was the introduction of the extended aspirin regimen as standard thromboprophylaxis. Objective To establish the appropriateness of this regimen by comparing venous thromboembolism rates in patients receiving extended aspirin to previous regimens. Setting The largest dedicated orthopaedic hospital in Ireland. Methods This was a retrospective cohort study. Data were collected from patient record software. All eligible patients undergoing primary total hip or knee replacement between 1st January 2010 and 30th June 2016 were included. Main outcome measure Venous thromboembolism up to 6 months post-operatively. Results Of the 6548 participants (55.3% female, mean age 65.4 years (± 11.8 years, 55.8% underwent total hip replacement), venous thromboembolism occurred in 65 (0.99%). Venous thromboembolism rate in both the inpatient enoxaparin group (n = 961) and extended aspirin group (n = 3460) was 1.04% and was 0.66% in the modified rivaroxaban group (n = 1212). Non-inferiority analysis showed the extended aspirin regimen to be equivalent to the modified rivaroxaban regimen. History of venous thromboembolism was the only significant demographic risk factor for post-operative venous thromboembolism (0.87% vs. 3.54%, p  = 0.0002). Conclusion In daily clinical practice, extended aspirin regimen is at least as effective as modified rivaroxaban for preventing clinically important venous thromboembolism among patients undergoing hip or knee arthroplasty who are discharged from the hospital without complications. Aspirin can be considered a safe and effective agent in the prevention of venous thromboembolism after total hip or total knee replacement.

Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study.

OBJECTIVES: Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions. DESIGN: Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF). SETTING AND PARTICIPANTS: A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland. MEASURES: Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed. RESULTS: Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants' effort to achieve "a fine balance" between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes ("human suffering"; "the interface between resident and nursing home"; and "power and knowledge: complex stakeholder dynamics"), which conceptualize how different nursing homes strike this "fine balance." CONCLUSIONS: Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that "fine balance" and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention.

Antibiotic prescribing in long-term care facilities: a meta-synthesis of qualitative research.

OBJECTIVES: The objective of this review was to synthesize the findings of qualitative studies investigating the factors influencing antibiotic prescribing in long-term care facilities (LTCFs). These findings will inform the development of future antimicrobial stewardship strategies (AMS) in this setting. METHODS: We searched Embase, PubMed, PsycInfo, Social Science Citations Index and Google Scholar for all qualitative studies investigating health care professionals' views on antibiotic prescribing in LTCFs. The quality of the papers was assessed using the Critical Appraisal Skills Programme (CASP) assessment tool for qualitative research. Thematic synthesis was used to integrate the emergent themes into an overall analytical theme. RESULTS: The synthesis of eight qualitative studies indicated that health care professionals and administrators have identified factors that influence antibiotic prescribing in LTCFs. These factors include variations in knowledge and practice among health care professionals, and the LTCF context, which is unique given the complex patient population and restricted access to doctors and diagnostic tests. The social factors underpinning the interaction between nurses, residents' families and doctors also influence decision making around antibiotic prescribing. The study also found that there is an acknowledged need for collaborative, evidence-based AMS specific to LTCFs, as antibiotic prescribing is heavily influenced by factors unique to this setting. CONCLUSION: This review highlighted the key contextual challenges for AMS in LTCFs. The findings provide an in-depth insight into the factors--such as the LTCF context, social factors, variability in knowledge and prescribing practices, and antimicrobial resistance--that impact on antibiotic prescribing and AMS strategies. These factors must be considered in order to ensure the feasibility and applicability of future AMS interventions.

Antimicrobial stewardship activities in hospitals in Ireland and the United Kingdom: a comparison of two national surveys.

BACKGROUND: Best practice guidelines recommend that a multidisciplinary Antimicrobial Management Team (AMT) conduct antimicrobial stewardship (AMS) activities in hospitals. In order to continuously improve AMS activities in Irish hospitals it is important to benchmark performance by comparison with other countries. OBJECTIVE: To compare the membership of AMTs and AMS activities conducted in Irish and United Kingdom (UK) hospitals. METHODS: A postal questionnaire to determine the membership and activities of AMTs was issued to the specialist antimicrobial pharmacist or pharmacist in charge at all Irish Hospitals and all UK National Health Service Hospitals. The membership of AMTs and the extent of AMS activities conducted were compared between the countries. RESULTS: The response rates to the surveys were 73% (n = 51) in Ireland and 33% in the UK (n = 273). 57% of Irish respondents reported having an AMT compared to 82% in the UK (p < 0.001). Significantly more AMTs in the UK had a specialist antimicrobial pharmacist on the team (95% UK, 69% Ireland, p < 0.001). A higher proportion of Irish respondents reported measuring the overall volume of antimicrobial prescribing (Ireland 85%, UK 72%, p = 0.057). A higher proportion of UK respondents reported measuring the appropriateness of antimicrobial prescribing (76% UK, 58% Ireland, p = 0.019) and the appropriateness of restricted antimicrobial prescribing (64% UK, 52% Ireland, p = 0.140). CONCLUSION: Irish and UK AMTs need to be supported to recruit and retain specialist antimicrobial pharmacists and to achieve higher rates of audit, prescription appropriateness review and feedback activities.

Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation.

OBJECTIVES: To explore healthcare professionals' views of antibiotic prescribing in long-term care facilities (LTCFs). To use the findings to recommend intervention strategies for antimicrobial stewardship in LTCFs. DESIGN: Qualitative semistructured interviews were conducted. The data were analysed by thematic content analysis. After the interviews, the emerging findings were mapped to the theoretical domains framework (TDF), and the behaviour change wheel and behaviour change technique (BCT) taxonomy were used to recommend future intervention strategies. PARTICIPANTS: Interviews were conducted with 37 healthcare professionals who work in LTCFs (10 general practitioners, 4 consultants, 14 nurses, 9 pharmacists) between December 2012 and March 2013. SETTING: Interviews were conducted in the greater Cork region. RESULTS: The main domains from the TDF which emerged were: 'Knowledge', 'Environmental context and resources', 'Social influences', 'Beliefs about consequences', 'Memory, attention and decision making', with the findings identifying a need for 'Behavioural regulation'. Many participants believed that antibiotic prescribing was satisfactory at their LTCF, despite the lack of surveillance activities. CONCLUSIONS: This study, using the TDF and BCT taxonomy, has found that antibiotic prescribing in LTCFs is influenced by many social and contextual factors. The challenges of the setting and patient population, the belief about consequences to the patient, and the lack of implementation of guidelines and knowledge regarding antibiotic prescribing patterns are significant challenges to address. On the basis of the study findings and the application of the TDF and BCT taxonomy, we suggest some practical intervention functions for antimicrobial stewardship in LTCFs.