Implementing antimicrobial stewardship in the Australian private hospital system: a qualitative study
Menino O. Cotta A B , Megan S. Robertson C , Caroline Marshall A B , Karin A. Thursky A , Danny Liew B and Kirsty L. Buising AA Victorian Infectious Diseases Service at the Doherty Institute, 792 Elizabeth Street Melbourne, Victoria 3000, Australia. Email: caroline.marshall@mh.org.au; karin.thursky@mh.org.au; kirsty.buising@mh.org.au
B Department of Medicine, Royal Melbourne Hospital Campus, University of Melbourne, Parkville, Vic. 3010, Australia. Email: danny.liew@mh.org.au
C Clinical Trials and Research Centre, Epworth HealthCare, 89 Bridge Road, Richmond, Vic. 3121, Australia. Email: megan.robertson@svhm.org.au
D Corresponding author. Email: menino.cotta@unimelb.edu.au
Australian Health Review 39(3) 315-322 https://doi.org/10.1071/AH14111
Submitted: 16 July 2014 Accepted: 3 November 2014 Published: 5 January 2015
Abstract
Objective To explore organisational factors and barriers contributing to limited uptake of antimicrobial stewardship (AMS) in Australian private hospitals and to determine solutions for AMS implementation.
Methods A qualitative study using a series of focus group discussions was conducted in a large private hospital making use of a semistructured interview guide to facilitate discussion among clinical and non-clinical stakeholders. A thematic analysis using five sequential components that mapped and interpreted emergent themes surrounding AMS implementation was undertaken by a multidisciplinary team of researchers.
Results Analysis revealed that autonomy of consultant specialists was perceived as being of greater significance in private hospitals compared with public hospitals. Use of an expert team providing antimicrobial prescribing advice and education without intruding on existing patient–specialist relationships was proposed by participants as an acceptable method of introducing AMS in private hospitals. There was more opportunity for nursing and pharmacist involvement, as well as empowering patients. Opportunities were identified for the hospital executive to market an AMS service as a feature that promoted excellence in patient care.
Conclusions Provision of advice from experts, championing by clinical leaders, marketing by hospital executives and involving nurses, pharmacists and patients should be considered during implementation of AMS in private hospitals.
What is known about the topic? Hospital-wide AMS programs have been shown to be an effective means to address the problem of accelerating antimicrobial resistance. However, current literature predominantly focuses on evaluation of AMS activities rather than on improving implementation success. In addition, most research on hospital AMS programs is from the public hospital sector. AMS is now part of new National Safety and Quality Health Service accreditation standards mandatory for all Australian hospitals; however, uptake of AMS in private hospitals lags behind public hospitals. Australian private hospitals are fundamentally different to public hospitals and there is more information needed to determine how AMS can best be introduced in these hospitals.
What does this paper add? Further investigation on how AMS can be implemented into private hospitals is urgently required. The qualitative work detailed in the present study provides a means of tailoring AMS strategies on the basis of organisational factors that may be considered unique to Australian private hospitals.
What are the implications for practitioners? Clinical and hospital executive stakeholders in the private hospital sector will be able to use solutions presented herein as a blueprint for designing sustainable AMS programs within their private healthcare facilities.
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