Super-Facilitators for Implementation of Leading Antimicrobial Stewardship Practices in Hospitals: A Qualitative...

Most hospitals have a basic infrastructure in place for their antimicrobial stewardship programs (ASPs). However, up to 50% of hospital-administered antimicrobials are prescribed inappropriately. To explore challenges and facilitators for effective implementation of leading practices (LPs), the authors conducted in-depth semistructured interviews with a sample of ASP leaders in Joint Commission-accredited hospitals across the United States.

In this qualitative study, the reserarchers conducted 30 in-depth interviews with a purposive sample of hospital ASP leaders from a cross section of hospitals of varied size and system membership. The framework approach was used to analyze and organize data. Factors that were critical for implementing multiple LPs across hospitals of different characteristics were termed super-facilitators.

Of 46 hospitals invited, 30 (10 large, 10 medium, 10 small) agreed to be interviewed. Of these, 22 hospitals were general medical/surgical, 6 were critical access hospitals (CAHs), and 2 were children's hospitals. The authors identified five super-facilitators: (1) having optimal electronic health records (EHRs), (2) dedicated staffing, (3) infectious diseases expertise, (4) hospital leadership commitment, and (5) physician champions that enhanced buy-in from clinicians.

Each of the five super-facilitators affect implementation of multiple leading antimicrobial stewardship practices. Given their inter-relationships, collective application of all five super-facilitators can support more effective and sustainable antimicrobial stewardship.