Queensland Surgical Antibiotic Prophylaxis: The barriers-enablers-ownership approach

Aim

To address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines.

Outcomes

1. Key understandings around the factors critical for surgical antibiotic prophylaxis improvement were generated, including the importance of senior clinical leadership, and the key contextual factors which can limit this leadership/engagement.
2. At the site with consistent senior engagement there was demonstrated consistent improvement with surgical antibiotic prescribing.

Background

The QSAP project was based on an extensive research programme investigating the complex dynamics that underpin antimicrobial prescribing decisions within Queensland hospitals. QSAP was a translational project, funded by an Advance Queensland Fellowship, and examined the use of social influences in combination with audit and feedback, in an intervention to improve surgical antibiotic prophylaxis prescribing.

Discussion

Evaluation

The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation.

Results 

The site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (pre study and post study). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance.

Conclusions 

The barriers-enablers- ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda.

Lessons learnt

Senior engagement is critical for improvements but is also contextually determined. Broader health service issues can limit the ability of senior clinicians to engage in a quality improvement process and therefore limit prescribing improvements.

Further Reading

Barriers-enablers-ownership approach: a mixed methods analysis of a social intervention to improve surgical antibiotic prescribing in hospitals | BMJ Open