Sustainability of antimicrobial stewardship programs in Australian rural hospitals: a qualitative study*
Jaclyn L. Bishop
A B C F , Thomas R. Schulz A B D , David C. M. Kong A B C E and Kirsty L. Buising A B D
A National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Vic. 3000, Australia. Email: Thomas.Schulz@mh.org.au; david.kong@monash.edu; Kirsty.Buising@mh.org.au
B Department of Medicine – Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Royal Parade, Melbourne, Vic. 3050, Australia.
C Pharmacy Department, Ballarat Health Services, Drummond Street, Ballarat, Vic. 3350, Australia.
D Victorian Infectious Diseases Service, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Vic. 3050, Australia.
E Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Vic. 3052, Australia.
F Corresponding author. Email: jaclynb@student.unimelb.edu.au
Australian Health Review 44(3) 415-420 https://doi.org/10.1071/AH19097
Submitted: 23 April 2019 Accepted: 8 August 2019 Published: 2 January 2020
Abstract
Objective The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals’ AMS programs.
Methods Lead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method.
Results Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements.
Conclusions Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care.
What is known about the topic? AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored.
What does this paper add? Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified.
What are the implications for practitioners? Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care.
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