Understanding the Determinants of Antimicrobial Prescribing within hospitals: The role of 'Prescribing Etiquette'
Clin Infect Dis. 2013 Apr 9;
Authors: Charani E, Castro-Sanchez E, Sevdalis N, Kyratsis Y, Drumright L, Shah N, Holmes A
Background. There is limited knowledge of the key determinants of antimicrobial prescribing behaviours (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programmes. Methods. Qualitative semi-structured interviews were conducted with doctors (10), pharmacists (10), nurses and midwives (19) in four 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 behaviours. Results. The APB of health care professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behaviour 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 which 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 'non-interference' 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.
PMID: 23572483 [PubMed - as supplied by publisher]