Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching
Objectives Timely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where AMS programmes for c...
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| Format: | Article |
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e064888.full |
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| author | Mieke L van Driel Adam Irwin Julia E Clark Leah S Sharman Minyon L Avent Vivian Lyall Jasmina Fejzic Nicolette Graham |
| author_facet | Mieke L van Driel Adam Irwin Julia E Clark Leah S Sharman Minyon L Avent Vivian Lyall Jasmina Fejzic Nicolette Graham |
| author_sort | Mieke L van Driel |
| collection | DOAJ |
| description | Objectives Timely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where AMS programmes for children are lacking. The aim of this study was to develop and evaluate user-led creation and implementation of an intervention package for early intravenous-to-oral switching at regional hospitals in Queensland, Australia.Design Guided by theory, a four-phase approach was used to: (1) develop multifaceted intervention materials; (2) review materials and their usage through stakeholders; (3) adapt materials based on user-feedback and (4) qualitatively evaluate health workers experiences at 6 months postintervention.Setting Seven regional hospitals in Queensland, Australia.Participants Phase 2 included 15 stakeholders; health workers and patient representatives (patient-guardians and Indigenous liaison officers). Phase 4 included 20 health workers across the seven intervention sites.Results Content analysis of health worker and parent/guardian reviews identified the ‘perceived utility of materials’ and ‘possible barriers to use’. ‘Recommendations and strategies for improvement’ provided adjustments for the materials that were able to be tailored to individual practice. Postintervention interviews generated three overarching themes that combined facilitators and barriers to switching: (1) application of materials, (2) education and support, and (3) team dynamics. Overall, despite difficulties with turnover and problems with the medical hierarchy, interventions aided and empowered antibiotic therapy decision-making and enhanced education and self-reflection.Conclusions Despite structural barriers to AMS for switching from intravenous-to-oral antibiotics in paediatric patients, offering a tailored multifaceted intervention was reported to provide support and confidence to adjust practice across a diverse set of health workers in regional areas. Future AMS activities should be guided by users and provide opportunities for tailoring tools to practice setting and patients’ requirements. |
| format | Article |
| id | doaj-art-4c3832ea17e64dc690ea7b03853d6ffa |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4c3832ea17e64dc690ea7b03853d6ffa2025-08-20T03:53:18ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-064888Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switchingMieke L van Driel0Adam Irwin1Julia E Clark2Leah S Sharman3Minyon L Avent4Vivian Lyall5Jasmina Fejzic6Nicolette Graham7General Practice Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia7 University Of Queensland Centre for Clinical Research, Herston, Queensland, AustraliaInfectious Diseases, Children`s Health Queensland Hospital and Health Service, Herston, Queensland, AustraliaGeneral Practice Clinical Unit, The University of Queensland, Brisbane, Queensland, AustraliaQueensland Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Queensland, AustraliaGeneral Practice Clinical Unit, The University of Queensland, Brisbane, Queensland, AustraliaFaculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, AustraliaInfection Management and Prevention Service, Queensland Children`s Hospital, Brisbane, Queensland, AustraliaObjectives Timely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where AMS programmes for children are lacking. The aim of this study was to develop and evaluate user-led creation and implementation of an intervention package for early intravenous-to-oral switching at regional hospitals in Queensland, Australia.Design Guided by theory, a four-phase approach was used to: (1) develop multifaceted intervention materials; (2) review materials and their usage through stakeholders; (3) adapt materials based on user-feedback and (4) qualitatively evaluate health workers experiences at 6 months postintervention.Setting Seven regional hospitals in Queensland, Australia.Participants Phase 2 included 15 stakeholders; health workers and patient representatives (patient-guardians and Indigenous liaison officers). Phase 4 included 20 health workers across the seven intervention sites.Results Content analysis of health worker and parent/guardian reviews identified the ‘perceived utility of materials’ and ‘possible barriers to use’. ‘Recommendations and strategies for improvement’ provided adjustments for the materials that were able to be tailored to individual practice. Postintervention interviews generated three overarching themes that combined facilitators and barriers to switching: (1) application of materials, (2) education and support, and (3) team dynamics. Overall, despite difficulties with turnover and problems with the medical hierarchy, interventions aided and empowered antibiotic therapy decision-making and enhanced education and self-reflection.Conclusions Despite structural barriers to AMS for switching from intravenous-to-oral antibiotics in paediatric patients, offering a tailored multifaceted intervention was reported to provide support and confidence to adjust practice across a diverse set of health workers in regional areas. Future AMS activities should be guided by users and provide opportunities for tailoring tools to practice setting and patients’ requirements.https://bmjopen.bmj.com/content/12/12/e064888.full |
| spellingShingle | Mieke L van Driel Adam Irwin Julia E Clark Leah S Sharman Minyon L Avent Vivian Lyall Jasmina Fejzic Nicolette Graham Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching BMJ Open |
| title | Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching |
| title_full | Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching |
| title_fullStr | Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching |
| title_full_unstemmed | Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching |
| title_short | Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching |
| title_sort | improving paediatric antimicrobial stewardship in remote and regional queensland hospitals development and qualitative evaluation of a tailored intervention for intravenous to oral antibiotic switching |
| url | https://bmjopen.bmj.com/content/12/12/e064888.full |
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