"There is no one to pick up the pieces": Sustainability of antibiotic stewardship programs in nursing homes
"There is no one to pick up the pieces": Sustainability of antibiotic stewardship programs in nursing homes
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DOI：
10.1017/ice.2020.1217
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发表时间：
2021-04-01
影响因子：
4.5
通讯作者：
Dumyati, Ghinwa K.
中科院分区：
文献类型：
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作者：
Seshadri, Sandhya;Felsen, Christina B.;Dumyati, Ghinwa K.
目的：描述护理之家的工作人员的经验和看法的因素，影响抗生素管理计划（ASP）的可持续性。方法：采用定性描述性设计，半结构化访谈的工作人员在9个不以营利为目的的护理之家与既定的ASP进行了录音。使用可持续发展框架和分析，以确定themes.Results：访谈进行了48临床和行政工作人员，以引起他们的看法ASP，并确定了7个主题的去识别transmitting的采访。ASP被认为是资源密集型和“数据驱动”，需要访问和解释的数据，不容易在许多养老院。虽然积极性和承诺，ASP冠军认为，他们不能单枪匹马地维持该计划。关注日常临床需求（即“火灾”）使得很难在实施之外取得进展，也很难达到可持续性的第2步。外部处方医生和法规的长期治疗习惯被认为阻碍了ASP的努力。与具有抗生素管理专业知识的外部顾问的合作被认为很重要，内部领导支持和跨学科合作的必要性也很重要。与会者认为，一致和持续的教育抗生素管理在所有工作人员levels.Conclusions的重要性：虽然许多相互关联的因素影响的ASP的可持续性，养老院可能能够维持ASP专注于3个关键领域：（1）明确的支持，由养老院领导，（2）外部合作伙伴关系与专业人士的抗生素管理的专业知识和内部跨专业合作，（3）一致的教育和培训所有工作人员。
Objective:To describe nursing home staff experiences and perceptions of the factors that impact the sustainability of an antibiotic stewardship program (ASP).Methods:Using a qualitative descriptive design, semistructured interviews with staff at 9 not-for-profit nursing homes with an established ASP were conducted and audio recorded. De-identified transcriptions of the interviews were coded using a sustainability framework and were analyzed to identify themes.Results:Interviews were conducted with 48 clinical and administrative staff to elicit their perceptions of the ASPs, and 7 themes were identified. ASPs were perceived to be resource intensive and "data driven," requiring access to and interpretation of data that are not readily available at many nursing homes. Though motivated and committed, ASP champions felt that they could not single-handedly sustain the program. Attending to daily clinical needs (ie, "fires") made it hard to progress beyond implementation and to reach step 2 of sustainability. Longstanding treatment habits by external prescribers and regulations were believed to impede ASP efforts. Partnerships with an external consultant with antibiotic stewardship expertise were considered important, as was the need for internal leadership support and collaboration across disciplinary boundaries. Participants felt that consistent and ongoing education on antibiotic stewardship at all staff levels was important.Conclusions:Although many interconnected factors impact the sustainability of an ASP, nursing homes may be able to sustain an ASP by focusing on 3 critical areas: (1) explicit support by nursing home leadership, (2) external partnerships with professionals with antibiotic stewardship expertise and internal interprofessional collaborations, and (3) consistent education and training for all staff.