Developing an Antimicrobial Stewardship Education Curriculum Framework
Date
2021-03-03
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Abstract
Background: Antimicrobial Stewardship (AS) education initiatives often neglect to account for the psychosocial factors driving antimicrobial prescribing (AP). Understanding these key factors is important in the design and implementation of tailored educational initiatives. Methods: This study which applied a mixed-methods embedded design, involved quantitative analysis of AS concerns observed by pharmacists through a clinical team rounds audit, as well as qualitative semi-structured interviews based on the Theoretical Domain Framework (TDF). Interviews (n=23) with staff and resident physicians, nurse practitioners and pharmacists were conducted for the Clinical Teaching Unit (CTU) and Pediatric Intensive Care Unit (PICU). We analyzed the data using deductive and inductive methods by mapping nodes from the TDF to a model for social determinants of antimicrobial prescribing (SDAP) in pediatrics. Facilitators and barriers to AP behaviour were identified and represented with respect to Kern’s Model of curriculum development targeted at future PICU and CTU AS education initiatives. Results: The quantitative phase served as an educational needs assessment, identifying chief AS practice (e.g., de-escalation) and antibiotics concerns. The qualitative phase explored AP behaviours and identified psychosocial facilitators and barriers for AS practice. Some facilitators included: 1. Collaboration and trust, 2. Shared decision-making with pharmacy and the Infectious Disease (ID) service, 3. Local accessible guidelines and 4. Overarching goals such as: doing right by the patient and feeling empowered as a prescriber. Some barriers included: 1. The norm of non-interference, 2. Professional comparisons including issues with hierarchy and egos, 3. Limited resources, 4. Feeling inadequately trained in AS, 5. Emotional prescribing in the face of clinical deterioration and diagnostic uncertainty and 6. Pejorative monitoring system. A conceptual framework was then developed using these facilitators and barriers for future educational initiatives for inpatient teams. Conclusions: This study contributes to the gap of knowledge around how best to optimize AS education for multidisciplinary teams. This is the first study in pediatrics taking into consideration the psychosocial drivers of AP behaviour in the context of team decisions around patient-centred clinical rounds. Mapping these facilitators and barriers to an established educational framework, allows for tailored curriculum development of future AS interventions.
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Keywords
antimicrobial, prescribing, education, stewardship, pediatrics
Citation
Constantinescu, C. M. (2021). Developing an Antimicrobial Stewardship Education Curriculum Framework (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.