Examining the implementation of a multi-site evidence-based intervention to reduce fluoroquinolone usage: A qualitative content analysis of staff interviews to identify facilitators and barriers

Clostridioides difficile infection is the most common healthcare-associated infection, causing almost half a million infections in the United States annually. Inappropriate antibiotic usage is a known risk factor. Antibiotic stewardship efforts aim to optimize prescribing. Evidence supports pre-prescription authorization as a highly effective intervention. A pre-prescription intervention for fluoroquinolone antibiotics via a computerized clinical decision support tool called a "best practice alert" (BPA) embedded in the patient's electronic health records has high potential for improving antibiotic stewardship. However, information is scant about the factors that might impact the uptake and effectiveness of this BPA and other similar evidence-based interventions when spread and adopted across multiple independent sites. Therefore, we utilized the Consolidated Framework for Implementation Research (CFIR) to understand the facilitators and barriers to the implementation process that influence clinical and implementation outcomes. In doing so, we conducted semi-structured interviews with 18 healthcare professionals across four hospitals. Our research team performed a qualitative analysis to understand the contextual factors influencing the implementation outcomes, such as acceptability and sustainability.

The following themes highlight the factors affecting the implementation of this healthcare innovation.

Designing interventions that are customizable and low maintenance.

Maturity level of the Antibiotic Stewardship Program.

Implementer's experience/attitudes in implementing healthcare innovations.

The ability to prioritize initiatives as the organization responds to unintended circumstances (e.g., COVID).

Adapting implementation approaches and strategies as technology spreads.