Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria.
Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria.
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DOI：
10.1016/j.ajic.2020.04.024
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发表时间：
2020-11
影响因子：
4.9
通讯作者：
Grigoryan L
中科院分区：
文献类型：
--
作者：
Goebel MC;Trautner BW;Wang Y;Van JN;Dillon LM;Patel PK;Drekonja DM;Graber CJ;Shukla BS;Lichtenberger P;Helfrich CD;Sales A;Grigoryan L
在对无症状菌尿症（ASB）实施抗生素管理干预之前，我们使用组织变革准备评估（ORCA）评估了变革的制度障碍。调查是在4个退伍军人事务部设施的住院医学和长期护理单位的纸上自我管理的。参与者包括供应商，护士和药剂师。该调查包括七个分量表：证据（感知的证据强度）和六个上下文分量表（组织上下文的可验证性）。根据5分Likert类型量表对反应进行评分。完成了104项调查（答复率=69.3%）。总体而言，证据分量表得分最高，资源分量表（平均2.8分）显著低于其他分量表（P < 0.001）。预算和人力资源的得分低于培训和设施资源的得分（两者均P < 0.001）。药剂师的员工文化分量表得分低于供应商（P = 0.04）。资源得分最低的研究中心（平均2.4）在领导力方面的得分也较低，药剂师在管理方面的努力也较低。尽管医疗保健专业人员认可关于不治疗ASB的证据，但抗生素管理的感知障碍包括资源和领导支持不足。这些发现为定制管理干预提供了目标，以最大限度地取得成功。
Prior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria (ASB), we assessed institutional barriers to change using the Organizational Readiness to Change Assessment (ORCA). Surveys were self-administered on paper in inpatient medicine and long-term care units at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists. The survey included seven subscales: evidence (perceived strength of evidence) and six context subscales (favorability of organizational context). Responses were scored on a 5-point Likert-type scale. 104 surveys were completed (response rate =69.3%). Overall, the evidence subscale had the highest score; the resources subscale (mean 2.8) was significantly lower than other subscales (P < 0.001). Scores for budget and staffing resources were lower than scores for training and facility resources (P < 0.001 for both). Pharmacists had lower scores than providers for the staff culture subscale (P = 0.04). The site with the lowest scores for resources (mean 2.4) also had lower scores for leadership and lower pharmacist effort devoted to stewardship. Although healthcare professionals endorsed the evidence about non-treatment of ASB, perceived barriers to antibiotic stewardship included inadequate resources and leadership support. These findings provide targets for tailoring the stewardship intervention to maximize success.
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DOI：
10.1177/1062860617716541
发表时间：
2018
期刊：
American journal of medical quality : the official journal of the American College of Medical Quality
影响因子：
--
作者：
Elango S;Szymczak JE;Bennett IM;Beidas RS;Werner RM
通讯作者：
Werner RM
影响因子：
4.9
作者：
Trautner, Barbara W.;Petersen, Nancy J.;Naik, Aanand D.
通讯作者：
Naik, Aanand D.
影响因子：
4.9
作者：
Grigoryan, Larissa;Naik, Aanand D.;Trautner, Barbara W.
通讯作者：
Trautner, Barbara W.
影响因子：
39
作者：
Trautner, Barbara W.;Grigoryan, Larissa;Naik, Aanand D.
通讯作者：
Naik, Aanand D.
影响因子：
8.3
作者：
Tukey, Melissa H.;Clark, Jack A.;Wiener, Renda Soylemez
通讯作者：
Wiener, Renda Soylemez