Critical points in the pathway of antibiotic prescribing in a children’s hospital:the Antibiotic Mapping of Prescribing (ABMAP) study


Background The WHO has identified Antimicrobial Resistance (AMR) as one of the most significant global risks facing modern medicine. Interventions to improve antibiotic prescribing have so far had limited impact. Aim To understand the barriers to effective antibiotic prescribing. Methods Mixed methodologies were used to investigate prescribing behaviours to identify the critical points in the antibiotic prescribing pathway for hospital inpatients. We assessed knowledge, experience or empowerment of prescribers, organisational factors and use of the laboratory. Phase 1 was an online survey to map barriers and facilitators to antibiotic prescribing (56 participants). Phase 2 consisted of focus groups and interviews to gain more understanding of prescribing behaviours (10 participants). Phase 3 was an online survey to obtain opinions on possible solutions (22 participants). Results Barriers to prescribing were: laboratory factors 71.6%, resource issues 40%, time constraints 17.5%, pressure from others 52%. Ninety-three percent of prescribers were concerned about AMR. In three scenarios only 9% were confident not to prescribe antibiotics for a patient without bacterial infection; 53% would prescribe unnecessarily broad spectrum antibiotics for pneumonia. Only 5% would de-escalate antibiotics in a microbiologically-confirmed bacteraemia. Despite concerns about AMR, prescribers did not perceive continuing antibiotics for individual patients might promote resistance. Prescribers were unwilling to change antibiotics out of hours and reported they preferred professional support for antibiotic prescribing. Conclusions There was a marked disparity between prescribers self-reporting of prescribing behaviour and responses to clinical scenarios. It was not clear whether training alone would change behaviours. Prescribers desired a directive mechanism to support antibiotic prescribing and stewardship.

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Divisions: College of Health & Life Sciences
College of Health & Life Sciences > School of Biosciences > Cell & Tissue Biomedical Research
College of Business and Social Sciences > School of Social Sciences & Humanities > Sociology and Policy
College of Health & Life Sciences > Aston Pharmacy School
College of Engineering & Physical Sciences
College of Engineering & Physical Sciences > Aston Institute of Materials Research (AIMR)
Additional Information: © 2018, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Publication ISSN: 1532-2939
Last Modified: 25 Mar 2024 08:27
Date Deposited: 06 Aug 2018 11:42
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Related URLs: https://www.sci ... 4031?via%3Dihub (Publisher URL)
PURE Output Type: Article
Published Date: 2019-04-01
Published Online Date: 2018-07-30
Accepted Date: 2018-07-25
Authors: Bashir, Amreen (ORCID Profile 0000-0002-0428-0922)
Gray, James
Bashir, Shahreen
Ahmed, Rabia
Theodosiou, Eirini (ORCID Profile 0000-0001-7068-4434)

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