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Physicians favor pediatric antimicrobial stewardship but question its efficiency
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Physicians and other prescribers at a large children’s hospital generally favored the hospital’s antimicrobial stewardship program but found parts of it to be inefficient, according to survey results published in Infection Control & Hospital Epidemiology.
“Children’s hospitals in the United States are increasingly implementing stewardship activities,” Julia E. Szymczak, PhD, an assistant professor of epidemiology at the University of Pennsylvania Perelman School of Medicine, and colleagues wrote.
Szymczak and colleagues wrote that a 2011 national survey of 38 children’s hospitals showed that 38% had a formal antimicrobial stewardship program (ASP) and 36% were in the process of implementing one. In an updated 2016 survey of 52 children’s hospitals, 94% reported having a formal ASP.
Between February and June 2017, Szymczak and colleagues conducted a cross-sectional survey of physicians and advanced practice providers — including certified registered nurse practitioners and physician assistants — working at Children’s Hospital of Philadelphia (CHOP).
The researchers noted that CHOP has had an ASP for 15 years. The ASP works as a prior authorization program with more than 50 targeted formulary antimicrobials that require its approval before use, as well as all nonformulary and inhaled antimicrobials. The program requires prescribers to contact the ASP for antimicrobial approval from 7 a.m. to 10 p.m. daily; however, they are allowed to order antimicrobials overnight without approval and follow up in the morning.
The researchers invited 394 prescribers to take the survey, and 160 (41%) responded. The respondents included 28.8% attending physicians, 26.8% general pediatrics residents, 15.6% fellow physicians and 28.8% advanced practice providers.
Scymczak and colleagues reported that the prescribers had “an overall favorable impression of the ASP,” and agreed that it improved the quality of care (92.4%). Most (73.8%) also said the ASP takes their judgment seriously.
However, the researchers reported that more than a quarter (26%) of respondents agreed that the ASP threatened efficiency, and 68.7% of respondents said they occasionally use workarounds to get antibiotics. The prescribers’ reasons for using workarounds included not wanting to change a therapy that appeared to be working, the attending physician disagreed with the ASP recommendation, and a desire to do everything possible for the child.
The researchers conducted an analysis of 133 free-text responses to the survey, finding that the prescribers perceived that the ASP “involved too many phone calls, caused communication breakdowns with the dispensing pharmacy and led to gaps between approvals and dispensing of antibiotics.”
“Engagement with prescribers via surveys that assess perceptions can identify areas for improvement to ensure that long-standing ASPs have maximum impact,” the researchers concluded. – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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