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Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study

OBJECTIVES: To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility. SETTING: 1300-bed tertiary care private hospital located in the state of Kerala, India. PARTICIPANTS: 31 semistructured interviews and 4 focus groups with hospital staff ranging from...

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Autores principales: Baubie, Kelsey, Shaughnessy, Catherine, Kostiuk, Lia, Varsha Joseph, Mariam, Safdar, Nasia, Singh, Sanjeev K, Siraj, Dawd, Sethi, Ajay, Keating, Julie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530383/
https://www.ncbi.nlm.nih.gov/pubmed/31092653
http://dx.doi.org/10.1136/bmjopen-2018-026193
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author Baubie, Kelsey
Shaughnessy, Catherine
Kostiuk, Lia
Varsha Joseph, Mariam
Safdar, Nasia
Singh, Sanjeev K
Siraj, Dawd
Sethi, Ajay
Keating, Julie
author_facet Baubie, Kelsey
Shaughnessy, Catherine
Kostiuk, Lia
Varsha Joseph, Mariam
Safdar, Nasia
Singh, Sanjeev K
Siraj, Dawd
Sethi, Ajay
Keating, Julie
author_sort Baubie, Kelsey
collection PubMed
description OBJECTIVES: To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility. SETTING: 1300-bed tertiary care private hospital located in the state of Kerala, India. PARTICIPANTS: 31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist. RESULTS: Key facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community. CONCLUSIONS: Opportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.
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spelling pubmed-65303832019-06-07 Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study Baubie, Kelsey Shaughnessy, Catherine Kostiuk, Lia Varsha Joseph, Mariam Safdar, Nasia Singh, Sanjeev K Siraj, Dawd Sethi, Ajay Keating, Julie BMJ Open Global Health OBJECTIVES: To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility. SETTING: 1300-bed tertiary care private hospital located in the state of Kerala, India. PARTICIPANTS: 31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist. RESULTS: Key facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community. CONCLUSIONS: Opportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings. BMJ Publishing Group 2019-05-14 /pmc/articles/PMC6530383/ /pubmed/31092653 http://dx.doi.org/10.1136/bmjopen-2018-026193 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Global Health
Baubie, Kelsey
Shaughnessy, Catherine
Kostiuk, Lia
Varsha Joseph, Mariam
Safdar, Nasia
Singh, Sanjeev K
Siraj, Dawd
Sethi, Ajay
Keating, Julie
Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study
title Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study
title_full Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study
title_fullStr Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study
title_full_unstemmed Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study
title_short Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study
title_sort evaluating antibiotic stewardship in a tertiary care hospital in kerala, india: a qualitative interview study
topic Global Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530383/
https://www.ncbi.nlm.nih.gov/pubmed/31092653
http://dx.doi.org/10.1136/bmjopen-2018-026193
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