Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals


Autoři: Courtney Ierano aff001;  Karin Thursky aff001;  Trisha Peel aff001;  Arjun Rajkhowa aff001;  Caroline Marshall aff001;  Darshini Ayton aff007
Působiště autorů: National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Victoria, Australia aff001;  Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia aff002;  Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia aff003;  Department of Infectious Diseases, Faculty of Medicine, Nursing and Health Sciences, Alfred Health/Monash University, Melbourne, Victoria, Australia aff004;  Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Victoria, Australia aff005;  Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, Victoria, Australia aff006;  Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia aff007
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225011

Souhrn

Background

Surgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in the hospital setting, with demonstrated high rates of inappropriateness. Decision-making for SAP is complex and multifactorial. A greater understanding of these factors is needed to inform the design of targeted antimicrobial stewardship interventions and strategies to support the optimization of SAP and its impacts on patient care.

Methods

A qualitative case study exploring the phenomenon of SAP decision-making. Focus groups were conducted with surgeons, anaesthetists, theatre nurses and pharmacists across one private and two public hospitals in Australia. Thematic analysis was guided by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivators-Behaviour (COM-B) model.

Results

Fourteen focus groups and one paired interview were completed. Ten of the fourteen TDF domains were identified as relevant. Thematic analysis revealed six significant themes mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes identified were: 1) Low priority for surgical antimicrobial prophylaxis prescribing skills; 2) Prescriber autonomy takes precedence over guideline compliance; 3) Social codes of prescribing reinforce established practices; 4) Need for improved communication, documentation and collection of data for action; 5) Fears and perceptions of risk hinder appropriate SAP prescribing; and 6) Lack of clarity regarding roles and accountability.

Conclusions

SAP prescribing is a complex process that involves multiple professions across the pre-, intra- and post-operative surgical settings. The utilisation of behaviour change frameworks to identify barriers and enablers to optimal SAP prescribing supports future development of theory-informed antimicrobial stewardship interventions. Interventions should aim to increase surgeon engagement, enhance the prioritisation of and accountability for SAP, and address the underlying social factors involved in SAP decision-making, such as professional hierarchy and varied perceptions or risks and fears.

Klíčová slova:

Antibiotics – Decision making – Nurses – Orthopedic surgery – Pharmacists – Plastic surgery and reconstructive techniques – Surgeons – Surgical and invasive medical procedures


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Článek vyšel v časopise

PLOS One


2019 Číslo 11