Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".
Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".
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DOI：
10.1093/cid/cit212
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Holmes A
中科院分区：
文献类型：
--
作者：
Charani E;Castro-Sanchez E;Sevdalis N;Kyratsis Y;Drumright L;Shah N;Holmes A
处方礼仪是抗菌药物处方行为的重要决定因素。处方礼仪承认临床决策的自主性和等级制度在影响实践中的作用。应利用现有的临床小组和临床领导力来影响抗菌药物处方行为。背景。 对于医院抗菌药物处方行为 (APB) 的关键决定因素知之甚少。为了成功设计、采用和实施抗菌药物管理计划中的质量改进干预措施，需要了解这些决定因素。方法。 对伦敦 4 家医院的医生 (n = 10)、药剂师 (n = 10)、护士和助产士 (n = 19) 进行了定性半结构化访谈。进行访谈直至主题达到饱和。对数据进行主题分析，以确定抗菌药物处方行为的关键决定因素。结果。 医疗保健专业人员的 APB 受一套文化规则的约束。抗菌药物处方是在临床领导者或前辈的行为影响初级医生的实践的环境中进行的。高级医生认为，在一种被认为是自主决策的文化中，他们可以免受政策和实践的约束，这种决策更多地依赖于个人知识和经验，而不是正式政策。处方者认同他们工作的临床小组，并根据这些小组内的普遍做法调整他们的 APB。同行抗菌药物处方实践中的“不干涉”文化可以防止干预同事的处方。这些文化规则表明“处方礼仪”的存在，它主导着医疗保健专业人员的 APB。规定礼仪创造了一个环境，在这个环境中，专业等级和临床小组成为 APB 的关键决定因素。结论。 为了影响个体医疗保健专业人员的抗菌药物处方，干预措施需要解决处方礼仪并利用现有临床小组内的临床领导力来影响实践。
Prescribing etiquette is an important determinant of antimicrobial prescribing behaviors. Prescribing etiquette recognizes clinical decision-making autonomy and the role of hierarchy in influencing practice. Existing clinical groups and clinical leadership should be utilized to influence antimicrobial prescribing behaviors. Background. There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Methods. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. Results. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of “noninterference” in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a “prescribing etiquette,” which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. Conclusions. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.
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影响因子：
5.2
作者：
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通讯作者：
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影响因子：
2.9
作者：
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通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1111/j.1365-2753.2008.00963.x
发表时间：
2009-02-01
影响因子：
2.4
作者：
Ljungberg, Christina;Lindblad, Asa Kettis;Tully, Mary
通讯作者：
Tully, Mary