Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study)
Objective To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic.Design Semistructured qualitative interview study.Setting National Health Service (NHS) trusts/health boards in England and Wales.Participants Clinicians from NHS trusts/health boards in Eng...
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BMJ Publishing Group
2023-12-01
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| author | Neil Powell Emma Thomas-Jones Paul Dark Tamas Szakmany Susan Hopkins Jonathan Sandoe Margaret Ogden Robert M West Enitan Carrol Lucy Brookes-Howell Philip Pallmann Bethany Shinkins Dominick Shaw Philip Howard Stacy Todd Thomas P Hellyer David G Partridge Graham Prestwich Sarah M Gerver Mahableshwar Albur Martin Llewelyn Joanne Euden Iain J McCullagh Josie Henley Ryan Hamilton Wakunyambo Maboshe Stuart E Bond Helena Parsons |
| author_facet | Neil Powell Emma Thomas-Jones Paul Dark Tamas Szakmany Susan Hopkins Jonathan Sandoe Margaret Ogden Robert M West Enitan Carrol Lucy Brookes-Howell Philip Pallmann Bethany Shinkins Dominick Shaw Philip Howard Stacy Todd Thomas P Hellyer David G Partridge Graham Prestwich Sarah M Gerver Mahableshwar Albur Martin Llewelyn Joanne Euden Iain J McCullagh Josie Henley Ryan Hamilton Wakunyambo Maboshe Stuart E Bond Helena Parsons |
| collection | DOAJ |
| description | Objective To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic.Design Semistructured qualitative interview study.Setting National Health Service (NHS) trusts/health boards in England and Wales.Participants Clinicians from NHS trusts/health boards in England and Wales.Method Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions.Results During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed.Conclusion This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic.Trial registration number ISRCTN66682918. |
| format | Article |
| id | doaj-art-3fe12ce0a430438f986fe9cc4519332a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-3fe12ce0a430438f986fe9cc4519332a2025-08-20T03:52:29ZengBMJ Publishing GroupBMJ Open2044-60552023-12-01131210.1136/bmjopen-2023-077117Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) 0Neil Powell1Emma Thomas-Jones2Paul Dark3Tamas Szakmany4Susan Hopkins5Jonathan Sandoe6Margaret Ogden7Robert M West8Enitan Carrol9Lucy Brookes-Howell10Philip Pallmann11Bethany Shinkins12Dominick Shaw13Philip Howard14Stacy Todd15Thomas P Hellyer16David G PartridgeGraham Prestwich17Sarah M GerverMahableshwar Albur18Martin Llewelyn19Joanne Euden20Iain J McCullaghJosie Henley21Ryan Hamilton22Wakunyambo Maboshe23Stuart E BondHelena ParsonsSPRinG Network, Severn and Peninsula Deaneries, UK1 Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, UKCentre for Trials Research, Cardiff University College of Biomedical and Life Sciences, Cardiff, UK8 Intensive Care Unit, University of Manchester, Salford, UK9 Critical Care Directorate, Aneurin Bevan University Health Board, Newport, UK2 UK Health Security Agency, London, UK17 Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK1Marie Curie Palliative Care Research Department, UCL, London, UK4 Leeds Institute of Health Sciences, University of Leeds, Leeds, UK18 Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UKCentre for Trials Research, Cardiff University, Cardiff, UK1 Centre for Trials Research, Cardiff University College of Biomedical and Life Sciences, Cardiff, UKLeeds Diagnosis and Screening Unit, University of Leeds, Leeds, UKNIHR Leicester BRC, Department of Respiratory Sciences, University of Leicester, Institute for Lung Health, Leicester, Leicestershire, UKSchool of Healthcare, University of Leeds, Leeds, UKTropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK11 Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK14 Public Patient Representative, Leeds, UK12 Microbiology, North Bristol NHS Trust, Bristol, UKDepartment of Microbiology and Infection, University Hospitals Sussex NHS Foundation Trust, Brighton, UKCentre for Trials Research, Cardiff University College of Biomedical and Life Sciences, Cardiff, UK1 School of Social Sciences, Cardiff University, Cardiff, UK13 School of Pharmacy, De Montfort University, Leicester, UK2 Cardiff University Centre for Trials Research, Cardiff, UKObjective To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic.Design Semistructured qualitative interview study.Setting National Health Service (NHS) trusts/health boards in England and Wales.Participants Clinicians from NHS trusts/health boards in England and Wales.Method Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions.Results During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed.Conclusion This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic.Trial registration number ISRCTN66682918.https://bmjopen.bmj.com/content/13/12/e077117.full |
| spellingShingle | Neil Powell Emma Thomas-Jones Paul Dark Tamas Szakmany Susan Hopkins Jonathan Sandoe Margaret Ogden Robert M West Enitan Carrol Lucy Brookes-Howell Philip Pallmann Bethany Shinkins Dominick Shaw Philip Howard Stacy Todd Thomas P Hellyer David G Partridge Graham Prestwich Sarah M Gerver Mahableshwar Albur Martin Llewelyn Joanne Euden Iain J McCullagh Josie Henley Ryan Hamilton Wakunyambo Maboshe Stuart E Bond Helena Parsons Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) BMJ Open |
| title | Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) |
| title_full | Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) |
| title_fullStr | Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) |
| title_full_unstemmed | Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) |
| title_short | Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study) |
| title_sort | developing a model for decision making around antibiotic prescribing for patients with covid 19 pneumonia in acute nhs hospitals during the first wave of the covid 19 pandemic qualitative results from the procalcitonin evaluation of antibiotic use in covid 19 hospitalised patients peach study |
| url | https://bmjopen.bmj.com/content/13/12/e077117.full |
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