Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional...

Area of Science:

• Healthcare Management
• Public Health Policy
• Infectious Disease Control

Background:

• Antimicrobial stewardship (AMS) is crucial for combating antimicrobial resistance (AMR), a major global health threat.
• Effective AMS relies on appropriate antibiotic prescribing, yet evidence on multi-professional implementation of national programs is limited.

Purpose of the Study:

• To elucidate the mechanisms influencing the implementation of a national antimicrobial stewardship programme.
• To identify barriers and enablers from the perspectives of diverse healthcare professionals.

Main Methods:

• Qualitative telephone interviews with 27 implementation leads and 15 focus groups with 72 doctors, nurses, and pharmacists across Scottish Health Boards.
• Thematic analysis of data, categorization of barriers/enablers, and interpretation using Normalisation Process Theory (NPT).

Main Results:

• Key barriers include organizational context and resource constraints, impacting nurse and pharmacist engagement.
• Conflicting priorities and limited role perception hindered buy-in from some consultants and non-prescribing staff.
• Lack of medical continuity and hierarchical issues constrained collective action; limited feedback capacity affected reflexive monitoring.

Conclusions:

• This study offers novel insights into multi-professional and multi-organizational barriers and enablers for national AMS program implementation.
• The application of Normalisation Process Theory (NPT) enhanced methodological rigor.
• Findings are significant for international policymakers and practitioners aiming to sustain hospital AMS programs.