Pre-implementation Assessment of An Antimicrobial Stewardship Program for Acute Respiratory Infections within Emergency and Urgent Care Settings

BACKGROUND: Inappropriate antibiotic use in emergency department (ED) and urgent care center (UCC) settings is a major public health concern, yet few antibiotic stewardship programs have been designed for these settings. We report a qualitative pre-implementation workflow analysis of five ED and UCC settings investigating the facilitators and barriers to incorporating an adapted CDC Get Smart antibiotic stewardship intervention for antibiotic-nonresponsive acute respiratory infections. METHODS: Seventeen semi-structured interviews were conducted at two academic medical centers using purposeful sampling of physicians, nurses, and administrators in adult and pediatric EDs and UCC. Interviews were recorded, transcribed, and analyzed independently by two researchers using NVivo 11. Grounded theory content analysis using the Evidence-Based Practice Implementation conceptual framework was performed for barriers and facilitators of implementation of antibiotic stewardship interventions in acute care settings and emergent themes. RESULTS: Facilitators to implementation included ability to display bilingual patient education materials while patients wait and within densely populated patient care areas, venues for provider education, the use of guidelines for antibiotic use, and willingness to use discharge tools like viral prescription pads. Barriers to implementation were communication deficiencies among providers, maintaining provider awareness, timing of interventions into the clinical workflow, and concern that long wait times may increase antibiotic prescribing. New ideas included incorporating stewardship education into the triage process. CONCLUSION: This study provides a framework for adaptation of existing antibiotic stewardship strategies to match the clinical workflow ED and UCC settings based on an analysis of the unique challenges inherent within these environments. It also provides a model for the development and pre-implementation assessment of antibiotic stewardship to account for, and adapt to, site-specific conditions. DISCLOSURES: All authors: No reported disclosures.