Exploring influences on intravenous-to-oral antibiotic switching: a qualitative interview study across healthcare...

Intravenous antibiotics are often continued longer than necessary leading to prolonged admission and increased infection risk. Existing research has reported barriers to IV-to-oral switch (IVOS) predominantly from a physician's perspective, leaving gaps in understanding how other healthcare professionals may influence IVOS decisions. This study aimed to explore influencers to IVOS among different healthcare professions.

Semi-structured interviews were conducted with doctors, nurses, pharmacists, and pharmacy technicians at an acute UK NHS hospital trust, selected through purposive sampling, to identify themes influencing IVOS. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted following Braun and Clarke's six-phase framework.

Identified themes were organized as barriers and enablers to IVOS. Prominent barriers included insufficient education and deference to perceived greater expertise of other professional groups. The perception that IVOS expertise resided with doctors discouraged other participants from advocating for IVOS. Additional barriers included fear of negative outcomes and low priority for IVOS. Strong enablers included collaborative teamwork, discharge readiness, and guidelines, which provided reassurance and reframed IVOS from individual risk to a collective responsibility.

This study underscores the complexity and persistence of barriers to IVOS despite established antimicrobial stewardship (AMS) initiatives. The findings of this study suggest that no single factor is responsible for this, but reflects the compounding effect of educational, hierarchical, and organizational challenges. For the successful introduction of IVOS, interventions must address these multiple components. Future efforts should focus on creating supportive systems which reposition IVOS as an expected standard of care across all healthcare professional groups.