Khumra Sharmila, Mahony Andrew A, Bergen Phillip J, Page Amy T, Elliott Rohan A
Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia.
Department of Pharmacy, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
BMC Med Educ. 2021 Apr 23;21(1):235. doi: 10.1186/s12909-021-02664-1.
Antimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists' self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions.
We conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models.
There were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24-72 h of prescription; p < 0.001. Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimization based on infection-specific factors, bug-drug mismatch, and inappropriate lack of spectra of antimicrobial activity. The median knowledge score (correct answers to knowledge questions) was 6 out of 9 (interquartile range, 5-7); key gaps were noted in antimicrobials' anaerobic spectrum, beta-lactam allergy assessment and dosing in immunocompromised patients. Clinical practice in inpatient areas, registration for 3-5 years and receipt of recent AMS education were associated with higher knowledge scores. More interactive modes of education delivery were preferred over didactic modes; p ≤ 0.01.
Gaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.
抗菌药物管理（AMS）计划通常在资源和范围上受到限制。因此，需要让医院药剂师更广泛地参与抗菌药物医嘱审核，以确保合理用药。我们评估了医院药剂师在审核抗菌药物处方方面的自我报告实践和信心，以及他们在进行AMS干预方面的知识。
我们于2017年10月在澳大利亚范围内开展了一项横断面调查。通过澳大利亚医院药剂师协会向医院药剂师发送了在线调查链接。使用线性回归模型探索与较高知识得分相关的因素。
共有439名受访者，其中272名（61.7%）来自大都市公立医院。药剂师在处方后24 - 72小时内更有可能评估静脉内、广谱或限制使用的抗生素的合理性，而不是窄谱口服抗生素；p < 0.001。50%或更少的受访者有信心识别与基于感染特异性因素的剂量优化、病菌 - 药物不匹配以及抗菌活性谱不适当缺乏相关的AMS干预措施。知识得分中位数（知识问题的正确答案）为9题中的6题（四分位间距，5 - 7）；在抗菌药物的厌氧谱、β - 内酰胺过敏评估以及免疫受损患者的给药方面发现了关键差距。住院区域的临床实践、3 - 5年的注册时间以及近期接受AMS教育与较高的知识得分相关。与讲授式模式相比，更倾向于采用互动性更强的教育模式；p≤0.01。
确定了医院药剂师在实践、信心和知识方面的差距，这可为教育策略的设计提供参考，以帮助改善澳大利亚医院的抗菌药物处方。
