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Threatened efficiency not autonomy: Prescriber perceptions of an established pediatric antimicrobial stewardship program

Published online by Cambridge University Press:  28 March 2019

Julia E. Szymczak Open the ORCID record for Julia E. Szymczak [Opens in a new window] ,
Eimear Kitt ,
Molly Hayes ,
Kathleen Chiotos ,
Susan E. Coffin ,
Emily R. Schriver ,
Ashley M. Patton ,
Talene A. Metjian  and
Jeffrey S. Gerber
Julia E. Szymczak*
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Eimear Kitt
Affiliation:
Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Molly Hayes
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Kathleen Chiotos
Affiliation:
Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
Emily R. Schriver
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Ashley M. Patton
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Talene A. Metjian
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
*
Author for correspondence: Julia E. Szymczak, Email: jszymcza@pennmedicine.upenn.edu
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Abstract

Background:

Implementing antimicrobial stewardship programs (ASPs) can be challenging due to prescriber resistance. Although barriers to implementing new ASPs have been identified, little is known about how prescribers perceive established programs. This information is critical to promoting the sustainability of ASPs.

Objective:

To identify how prescribers perceive an established pediatric inpatient ASP that primarily utilizes prior authorization.

Methods:

We conducted a cross-sectional survey administered from February through June 2017 in a large children’s hospital. The survey contained closed- and open-ended questions. Descriptive statistics and thematic content analysis approaches were used to analyze responses.

Results:

Of 394 prescribers invited, 160 (41%) responded. Prescribers had an overall favorable impression of the ASP, believing that it improves the quality of care (92.4% agree) and takes their judgment seriously (73.8%). The most common criticism of the ASP was that it threatened efficiency (26.0% agreed). In addition, 68.7% of respondents reported occasionally engaging in workarounds. Analysis of 133 free-text responses revealed that prescribers perceived that interacting with the ASP involved too many phone calls, caused communication breakdowns with the dispensing pharmacy, and led to gaps between approval and dispensing of antibiotics. Reasons given for workarounds included not wanting to change therapy that appears to be working, consultant disagreement with ASP recommendations, and the desire to do everything possible for patients.

Conclusions:

Prescribers had a generally favorable opinion of an established ASP but found aspects to be inefficient. They reported engaging in workarounds occasionally for social and emotional reasons. Established ASPs should elicit feedback from frontline prescribers to optimize program impact.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 5 , May 2019 , pp. 522 - 527
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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