Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria.

Autor: Goebel MC; Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic address: mcgoebel@bcm.edu., Trautner BW; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Wang Y; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA., Van JN; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA., Dillon LM; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA., Patel PK; Division of Infectious Diseases, Department of Medicine, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA., Drekonja DM; Division of Infectious Diseases and International Medicine, University of Minnesota Medical School and Minneapolis VA Health Care System, Minneapolis, MN, USA., Graber CJ; Infectious Diseases Section, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Shukla BS; Department of Medicine, University of Miami Miller School of Medicine and the Miami VA Healthcare System, Miami, FL, USA., Lichtenberger P; Division of Infectious Disease, University of Miami Miller School of Medicine and the Miami VA Healthcare System, Miami, FL, USA., Helfrich CD; Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA; Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA., Sales A; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA., Grigoryan L; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Jazyk: angličtina
Zdroj: American journal of infection control [Am J Infect Control] 2020 Nov; Vol. 48 (11), pp. 1322-1328. Date of Electronic Publication: 2020 May 08.
DOI: 10.1016/j.ajic.2020.04.024
Abstrakt: Background: Prior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria (ASB), we assessed institutional barriers to change using the Organizational Readiness to Change Assessment.
Methods: Surveys were self-administered on paper in inpatient medicine and long-term care units at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists. The survey included 7 subscales: evidence (perceived strength of evidence) and six context subscales (favorability of organizational context). Responses were scored on a 5-point Likert-type scale.
Results: One hundred four surveys were completed (response rate = 69.3%). Overall, the evidence subscale had the highest score; the resources subscale (mean 2.8) was significantly lower than other subscales (P < .001). Scores for budget and staffing resources were lower than scores for training and facility resources (P < .001 for both). Pharmacists had lower scores than providers for the staff culture subscale (P = .04). The site with the lowest scores for resources (mean 2.4) also had lower scores for leadership and lower pharmacist effort devoted to stewardship.
Conclusions: Although healthcare professionals endorsed the evidence about nontreatment of ASB, perceived barriers to antibiotic stewardship included inadequate resources and leadership support. These findings provide targets for tailoring the stewardship intervention to maximize success.
(Copyright © 2020 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.)
Databáze: MEDLINE
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