A Patient and Healthcare Worker-Informed Approach to Identifying Barriers to and Strategies for Antibiotic Stewardship at the Hospital-to-Home Transition

项目摘要 抗生素耐药性在全球范围内不断增加，主要是由于过度使用抗生素。抗生素管理 (AS)解决抗生素耐药性问题，确保只有需要抗生素的患者才能获得抗生素， 患者在正确的时间以正确的剂量在正确的持续时间内接受正确的药物治疗。AS干预 通常集中在医院，长期护理和孤立的流动环境。然而，患者也 接受抗生素，因为他们从一个护理环境过渡到另一个。出院抗生素决策 仍然是AS的一个重要但未得到充分解决的目标，我们需要更好地了解如何 改进这个过程。优化AS还需要注意出院后的过程。的大多数部件 在从医院到家庭的过渡过程中，病人主导的任务是在正确的时间，正确的时间服用抗生素。 剂量和正确的持续时间-并且一旦患者回到家中，必须及时进行。药物 管理（MM）是指根据处方获得，管理和服用药物的能力。 方案.在我们的老年人从医院到家庭过渡期间的MM模型中，我们确定了 医疗保健工作者发起的流程以及患者和患者发起的流程必须成功地 为患者提供最佳的处方治疗。然而，目前尚不清楚抗生素MM如何 符合一般MM模型。到目前为止，还没有研究将出院抗生素决策与 患者主导的抗生素MM作为一系列相互关联的过程中必要的AS在医院到家庭 过渡我们将使用参与式设计和多种方法，积极吸引利益相关者参与描述 出院抗生素决策和抗生素MM，以确定AS的障碍和策略， 从医院到家庭的过渡目的1：确定在医院到家庭过渡期间AS的障碍， 出院抗生素决策和患者主导的抗生素MM的综合过程。 MM的过渡模型作为基础框架，我们将采访医疗团队成员利益相关者 并进行基于家庭的背景调查，对出院的患者进行半结构化访谈， 抗生素，关于出院抗生素决策和患者主导抗生素的交织过程 毫米这些方法将帮助我们在从医院到家庭的过渡过程中识别AS的障碍，并制定一个 在医院到家庭过渡期间，AS的综合流程图。目标2：完成主动风险 评估，以确定在医院到家庭过渡期间减轻AS障碍的策略。我们 我将把这些数据呈现给临床医生、患者和护理人员，他们将经历一个失败模式和影响， 分析（FMEA）风险评估，以制定和优先考虑解决AS障碍的潜在策略 在医院到家庭的过渡期间。我们将使用已识别的障碍、策略和集成流程 地图建议未来干预的组成部分，优化出院抗生素决策 抗生素MM

Project Abstract Antibiotic resistance is increasing worldwide, largely driven by excessive antibiotic use. Antibiotic stewardship (AS) addresses antibiotic resistance by ensuring that only patients who require antibiotics get them, and that patients receive the right medication at the right time at the right dose for the right duration. AS interventions have typically focused on hospital, long-term care, and ambulatory settings in isolation. However patients also receive antibiotics as they transition from one care setting to another. Discharge antibiotic decision-making remains an important but under-addressed target for AS, and we require a better understanding of how to improve this process. Optimizing AS also requires attention to post-discharge processes. Most components of AS during the hospital-to-home transition are patient led tasks--taking the antibiotic at the right time, at the right dose, and for the right duration—and must occur in a timely way once the patient arrives home. Medication management (MM) refers to the ability to obtain, administer, and take medications according to a prescribed regimen. In our model of MM during the hospital-to-home transition among older adults, we identified healthcare worker-initiated processes and patient and caregiver-initiated processes that must be successfully completed for patients to optimally receive prescribed treatments. However it is unclear how antibiotic MM may fit into a general MM model. To date, no research has integrated discharge antibiotic decision-making with patient-led antibiotic MM as a series of interrelated processes necessary for AS during the hospital-to-home transition. We will use participatory design and multiple methods to actively engage stakeholders in describing discharge antibiotic decision-making and antibiotic MM to identify barriers to and strategies for AS during the hospital-to-home transition. Aim 1: To identify barriers to AS during the hospital-to-home transition in the integrated processes of discharge antibiotic decision-making and patient-led antibiotic MM. Using the Transition Model of MM as the underlying framework, we will interview healthcare team member stakeholders and perform home-based contextual inquiry with semi-structured interviews of patients discharged on antibiotics, about the intertwined processes of discharge antibiotic decision-making and patient-led antibiotic MM. These methods will help us identify barriers to AS during the hospital-to-home transition and develop an integrated process map for AS during the hospital-to-home transition. Aim 2: To complete a proactive risk assessment to identify strategies to mitigate barriers to AS during the hospital-to-home transition. We will present this data to clinicians and patients and caregivers, who will go through a Failure Modes and Effects Analysis (FMEA) risk assessment to develop and prioritize potential strategies for addressing barriers to AS during the hospital-to-home transition. We will use identified barriers, strategies, and the integrated process map to suggest components of a future intervention that optimizes both discharge antibiotic decision-making and antibiotic MM.