Goulopoulos Anne, Rofe Olivia, Kong David, Maclean Andrew, O'Reilly Mary
Pharmacy Department, Eastern Health, Melbourne, Victoria, Australia.
Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2019 Oct;31(5):787-796. doi: 10.1111/1742-6723.13251. Epub 2019 Mar 28.
To explore the attitudes and beliefs of Australian ED clinicians towards antimicrobial stewardship in the ED.
Semi-structured one-to-one interviews were conducted with ED clinicians between March and October 2015. Participants were identified via purposive and snowball sampling. Questionnaires were developed using the literature. Interviews were audio-recorded, transcribed and analysed using thematic analysis via the framework approach. Two researchers coded independently, with one using QSR International's NVivo 10 software and the other manually. Emergent themes were identified and classified.
Twenty-two clinicians (eight doctors, eight nurses and six pharmacists) from seven institutions participated. Participants were aware and concerned about antimicrobial resistance. Clinicians were divided based on their opinion on whether antimicrobials are prescribed appropriately and judiciously in the ED, with many perceiving prescribing to be inappropriate. Prior knowledge of the term 'Antimicrobial Stewardship' was demonstrated by doctors and pharmacists, with a relative lack of awareness by nurses. Four main themes were identified as both barriers and facilitators to antimicrobial stewardship in the ED: individual healthcare provider, resource, organisational and cultural. Uncertainty of diagnosis, time and resource pressures, reliance on previous experience and lack of access to expert opinion were perceived barriers. To facilitate appropriate prescribing, clinicians emphasised the need for routine education and feedback, adequate staffing, robust guidelines, senior medical clinician advocacy and multidisciplinary support.
Australian ED clinicians were aware of antimicrobial resistance. Many perceive injudicious antimicrobial use as problematic. Consideration of ED clinicians' perceived barriers and facilitators might enhance implementation of antimicrobial stewardship programmes in EDs.
探讨澳大利亚急诊科临床医生对急诊科抗菌药物管理的态度和看法。
2015年3月至10月对急诊科临床医生进行了半结构化一对一访谈。通过立意抽样和滚雪球抽样确定参与者。根据文献制定问卷。访谈进行录音、转录，并通过框架方法采用主题分析法进行分析。两名研究人员独立编码，一名使用QSR国际公司的NVivo 10软件，另一名手动编码。确定并分类出现的主题。
来自七个机构的22名临床医生（8名医生、8名护士和6名药剂师）参与了研究。参与者意识到并关注抗菌药物耐药性问题。临床医生在急诊科抗菌药物处方是否恰当和合理的问题上存在分歧，许多人认为处方不合理。医生和药剂师表现出对抗菌药物管理这一术语的先验知识，而护士相对缺乏认识。确定了急诊科抗菌药物管理的四个主要主题，既是障碍也是促进因素：个体医疗服务提供者、资源、组织和文化。诊断的不确定性、时间和资源压力、依赖既往经验以及无法获得专家意见被视为障碍。为促进合理处方，临床医生强调需要进行常规教育和反馈、充足的人员配备、完善的指南、资深医学临床医生的支持和多学科支持。
澳大利亚急诊科临床医生意识到抗菌药物耐药性问题。许多人认为抗菌药物使用不当是个问题。考虑急诊科临床医生所感知的障碍和促进因素可能会加强急诊科抗菌药物管理计划的实施。
