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1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics

BACKGROUND: Improved antibiotic decision-making during the hospital-to-home transition is an important but under-addressed target for antimicrobial stewardship. This study aims to provide a healthcare worker-informed approach to characterize prescriber antibiotic decision-making and patient medicati...

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Autores principales: Sharara, Sima L, Cosgrove, Sara E, Arbaje, Alicia, Gurses, Ayse P, Dzintars, Kate, Keller, Sara C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810988/
http://dx.doi.org/10.1093/ofid/ofz360.927
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author Sharara, Sima L
Cosgrove, Sara E
Cosgrove, Sara E
Arbaje, Alicia
Gurses, Ayse P
Dzintars, Kate
Keller, Sara C
author_facet Sharara, Sima L
Cosgrove, Sara E
Cosgrove, Sara E
Arbaje, Alicia
Gurses, Ayse P
Dzintars, Kate
Keller, Sara C
author_sort Sharara, Sima L
collection PubMed
description BACKGROUND: Improved antibiotic decision-making during the hospital-to-home transition is an important but under-addressed target for antimicrobial stewardship. This study aims to provide a healthcare worker-informed approach to characterize prescriber antibiotic decision-making and patient medication management at discharge to identify barriers to and strategies for antibiotic stewardship during the hospital-to-home transition. METHODS: Semi-structured interviews were conducted at an academic medical center with relevant stakeholders including house staff (n = 10), nurses (n = 2), nurse practitioners (n = 5), inpatient pharmacists (n = 4), and discharge coordinators (n = 2). Interviews focused on challenges to antibiotic decision-making and patient medication management at discharge. Transcripts were independently coded and analyzed by two physicians using the constant comparative method. RESULTS: We identified four main barriers to antibiotic decision-making at hospital discharge: (1) uncertainty over antibiotic choice (due to lack of microbiology data), (2) pressure to discharge, (3) lack of control over antibiotic decision-making (attending-led decision with little room for input), and (4) lack of awareness of cost and insurance coverage. We also identified challenges to patient medication management specific to patient education: (1) role ambiguity around who provides education and (2) lack of education to patients around side effects. To improve antibiotic decision-making, prescribers relied heavily on institutional guidelines and interaction with experts in informing antibiotic choices, and used multidisciplinary approaches to verify antibiotic cost and availability. Five strategies to improve medication management were proposed: (1) assessing patient health literacy when providing instructions, (2) an in-hospital trial of the oral antibiotic to ensure tolerance, (3) ensuring the patient leaves the hospital with the antibiotic in hand, (4) care coordination after discharge, and (5) close follow-up with prescribers after discharge. CONCLUSION: Our findings identify barriers to discharge antibiotic decision-making and medication management that allow for targeted interventions to improve antibiotic decision-making during the hospital-to-home transition. DISCLOSURES: Sara E. Cosgrove, MD, MS, Basilea: Consultant; Theravance: Consultant.
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spelling pubmed-68109882019-10-28 1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics Sharara, Sima L Cosgrove, Sara E Cosgrove, Sara E Arbaje, Alicia Gurses, Ayse P Dzintars, Kate Keller, Sara C Open Forum Infect Dis Abstracts BACKGROUND: Improved antibiotic decision-making during the hospital-to-home transition is an important but under-addressed target for antimicrobial stewardship. This study aims to provide a healthcare worker-informed approach to characterize prescriber antibiotic decision-making and patient medication management at discharge to identify barriers to and strategies for antibiotic stewardship during the hospital-to-home transition. METHODS: Semi-structured interviews were conducted at an academic medical center with relevant stakeholders including house staff (n = 10), nurses (n = 2), nurse practitioners (n = 5), inpatient pharmacists (n = 4), and discharge coordinators (n = 2). Interviews focused on challenges to antibiotic decision-making and patient medication management at discharge. Transcripts were independently coded and analyzed by two physicians using the constant comparative method. RESULTS: We identified four main barriers to antibiotic decision-making at hospital discharge: (1) uncertainty over antibiotic choice (due to lack of microbiology data), (2) pressure to discharge, (3) lack of control over antibiotic decision-making (attending-led decision with little room for input), and (4) lack of awareness of cost and insurance coverage. We also identified challenges to patient medication management specific to patient education: (1) role ambiguity around who provides education and (2) lack of education to patients around side effects. To improve antibiotic decision-making, prescribers relied heavily on institutional guidelines and interaction with experts in informing antibiotic choices, and used multidisciplinary approaches to verify antibiotic cost and availability. Five strategies to improve medication management were proposed: (1) assessing patient health literacy when providing instructions, (2) an in-hospital trial of the oral antibiotic to ensure tolerance, (3) ensuring the patient leaves the hospital with the antibiotic in hand, (4) care coordination after discharge, and (5) close follow-up with prescribers after discharge. CONCLUSION: Our findings identify barriers to discharge antibiotic decision-making and medication management that allow for targeted interventions to improve antibiotic decision-making during the hospital-to-home transition. DISCLOSURES: Sara E. Cosgrove, MD, MS, Basilea: Consultant; Theravance: Consultant. Oxford University Press 2019-10-23 /pmc/articles/PMC6810988/ http://dx.doi.org/10.1093/ofid/ofz360.927 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Sharara, Sima L
Cosgrove, Sara E
Cosgrove, Sara E
Arbaje, Alicia
Gurses, Ayse P
Dzintars, Kate
Keller, Sara C
1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics
title 1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics
title_full 1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics
title_fullStr 1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics
title_full_unstemmed 1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics
title_short 1063. A Healthcare Worker-Informed Approach to the Hospital-to-Home Transition on Oral Antibiotics
title_sort 1063. a healthcare worker-informed approach to the hospital-to-home transition on oral antibiotics
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810988/
http://dx.doi.org/10.1093/ofid/ofz360.927
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