Back to Search
Start Over
Understanding the Determinants of Antimicrobial Prescribing Within Hospitals: The Role of 'Prescribing Etiquette'
- Source :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, Clinical Infectious Diseases
- Publication Year :
- 2013
- Publisher :
- Oxford University Press, 2013.
-
Abstract
- Prescribing etiquette is an important determinant of antimicrobial prescribing behaviors. Prescribing etiquette recognizes clinical decision-making autonomy and the role of hierarchy in influencing practice. Existing clinical groups and clinical leadership should be utilized to influence antimicrobial prescribing behaviors.<br />Background. There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Methods. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. Results. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of “noninterference” in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a “prescribing etiquette,” which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. Conclusions. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.
- Subjects :
- Microbiology (medical)
Health Personnel
education
Psychological intervention
Pharmacist
Qualitative property
Drug Prescriptions
Interviews as Topic
03 medical and health sciences
0302 clinical medicine
Professional Competence
Nursing
Health care
London
Medicine
Antimicrobial stewardship
Humans
030212 general & internal medicine
Personal knowledge base
Articles and Commentaries
0303 health sciences
prescribing etiquette
030306 microbiology
business.industry
Health services research
R1
antimicrobial prescribing
Hospitals
3. Good health
Anti-Bacterial Agents
Health-promotion
Infectious Diseases
Health Services Research
Thematic analysis
business
RA
prescribing behavior
Subjects
Details
- Language :
- English
- ISSN :
- 15376591 and 10584838
- Volume :
- 57
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
- Accession number :
- edsair.doi.dedup.....8ff05dd4ba8026ef03c745076dc3ba7b