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Table 1 Overview of literature scan and extracted implementation topics

From: Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

#

Author (s)

Year

Title

Study description

Extracted implementation topics

1

Bannan, Buono, McLaws, Gottlieb

2009

Survey of medical staff attitudes to an antibiotic approval and stewardship program

Design:

- restriction as intervention

Questionnaire with 40 questions focused on restriction and approval

- authorization as intervention

Interest:

- advice as communication

- education as intervention

Attitude

- stop-order (withholding pharmacy) as intervention

- costs, appropriate use, resistance, time as outcomes

- pager as communication

- possible stakeholders in team

2

Barlam, DiVall

2006

Antibiotic-stewardship practices at top academic centers throughout the united states and at hospitals throughout Massachusetts

Design:

- multifaceted programs

Two surveys

- time of start with ASP

Interest:

- funding/financial support

ASP components

- (formulary) restriction as intervention

- solicited input from ID as communication

- costs, improved use, adverse effects, resistance, compliance, DDDs, clinical outcomes as outcomes

- aiming prophylaxis

- aiming only targeted antibiotics

- aiming antibiotic therapy at order

- aiming initial therapy

- recommendations as intervention (day 3 bundle)

- culture data as communication

- possible stakeholders in team

- approval as intervention

- review as communication

- consult as communication

- computerized order entry as communication

- stop-order as intervention

- IV-PO switch as intervention

- clinical practical guidelines as intervention

- evaluation as intervention (benchmarking)

- support and time needed from physicians

- rounds, didactics, program, consults/feedback as education

3*

Burgmann, Janata, Allerberger, Frank

2008

Hospital antibiotic management in Austria – results of the ABS maturity survey of the ABS International group

Design:

- data evaluation as intervention (benchmarking)

Survey

- AB consumption data as outcomes

Interest:

- hospital/department/ward levels of benchmarking

5 categories of maturity

- feedback of benchmarking as communication

- possible stakeholders in team

- guidelines for dosage, drug costs, IV-PO switch

- guidelines for antibiotic treatment

- guidelines for prophylaxis

- education as intervention (seminars, literature)

- financial resources

- cooperation with other hospitals

4

Buyle, Metz-Gercek, Mechtler, Kern, Robays, Vogelaers, Struelens

2013

Development and validation of potential structure indicators for evaluating antimicrobial stewardship programmes in European hospitals

Design:

- bedside advice as communication

Expert panel + validation survey

- rounds as intervention

- frequency of team meetings

Interest:

- audit as intervention

Potential structure indicators for ASP

- possible stakeholders in team

- formulary as intervention

- updating formulary

- stop order as intervention

- guidelines for microbiological documented therapy, empirical therapy, prophylaxis, iv-po switches

- updating guidelines

- clinical decision aid as IT

- mandate from management

- FTEs

- Education as interventions

- passive methods, interactive methods as education

- evaluation as intervention

- resistance data, consumption data,

- hospital/department/ward levels of benchmarking

- total DDDs, # of infections as outcomes

5

Cooke, Alexander, Charani, Hand, Hills, Howard, Jamieson, Lawson, Richardson, Wade

2010

Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals

Design:

- guidelines as intervention

ASAT toolkit (checklist)

- formulary as intervention

Interest:

- restriction as intervention

Levels of antimicrobial stewardship

- IV-PO switches as intervention

- guidelines for prophylaxis as intervention

- adherence as outcome

- education as intervention

- training as education

- information systems as IT

- digital prescribing as IT

- possible stakeholders in team

6

Dumartin, Rogues, Amadeo, Pefau, Venier, Parneix, Maurain

2011

Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005–2008

Design:

- frequency in meetings

Survey

- available human resources

Interest:

- digital prescription, pharmaceutical analysis, dispensation, digital link between lab, pharm, wards as IT

Checking whether legal framework is present

- restriction as intervention

- stop order as intervention

- first-line, prophylaxis as guidelines

- audits as intervention/communication

- evaluation feedback as communication

- education as intervention

- Formulary as intervention

- ab consumption as benchmarking

- DDDs, resistance as outcomes (and communication)

- possible stakeholders in team

7

van Gastel, Costers, Peetermans, Struelens

2010

Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting survey

Design:

- Possible stakeholders in team

Questionnaire

- consultation per phone, email, intranet, face-to-face, staff meetings as communication

Interest:

- formulary as intervention

Level of AMT activities

- guidelines for empirical and prophylaxis

- updates of formulary and guidelines

- restriction as intervention

- approval/review as intervention

- concurrent review/audit as intervention

- de-escalation as intervention

- stop order as intervention

- order forms as intervention

- IV-PO switch as intervention

- consumption and resistance as outcomes

- by hospital/unit or by antibiotic type

- feedback of outcomes

8

Greater New York Hospital Association

2011

Antimicrobial stewardship toolkit

Design:

- benchmark and review antibiotic use (patterns)

Best practice

- review resistance

Interest:

- IT infrastructure

Implementation toolkit

- possible stakeholders in team

- aim for common infections, pathogens, agents

- rollout: hospital vs. ward

- available resources

- strategy:

- guidelines for diagnosis, treatment, duration, dose optimization, IV-PO, streamlining/de-escalation

- formulary as intervention

- restriction as intervention

- education as intervention

- prospective review as intervention

- stickers, notes, face-to-face as communication

- data collection (benchmarking)

- usage, clinical, microbiologic, costs as data

9

Hulscher, Grol, van der Meer

2010

Antibiotic prescribing in hospitals: a social and behavioral scientific approach

Design:

- formulary as intervention

Review

- order form as intervention

Interest:

- restriction as intervention

socio-cultural factors of ASP

- stop orders as intervention

- infection control committee

- guidelines as intervention

- review as intervention

- rounds as intervention

- telephone advice as intervention

- improve infrastructure

- education as intervention

- conferences, seminars, skill training programs as education

- individual instructions (outreach, academic detailing)

- feedback of outcomes

- decision support via IT

10

Nault, Beaudoin, Thirion, Gosselin, Cossette, Valiquette

2008

Antimicrobial stewardship in acute care centres: survey of 68 hospitals in Quebec

Design:

- Duration of ASP or busy setting up

Questionnaire

- distributed units, DDDs, acquisition costs as benchmarking data

Interest:

- direct interaction as intervention (written or phone)

Proportion and nature of programs

- education as intervention

- stop orders as intervention

- auto substitution

- formulary restriction as interventions

- local guidelines as intervention

- preauthorization as intervention

- antibiotic cycling as intervention

- decision support systems as intervention

- possible stakeholders in team

11

Pulcini, Williams, Molinari, Davey, Nathwani

2011

Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland

Design:

- local guidelines as intervention

Survey

- presence of team-

Interest:

- approval as intervention

Perception and prescribing practice

- IV-PO switch protocol

- advice from ID physician, senior, microbiologist, pharmacist or team as intervention

- face-to-face, phone, consult upon request as communication

- lectures, workshops, informal education, web-based learning, self-directed learning as education

- possible stakeholders in team

- computer aided prescribing as IT

- resistance data availability

12

Thern

2013

Selection of hospital antimicrobial prescribing quality indicators:

Design:

- possible stakeholders in team

a consensus among German antibiotic stewardship (ABS) networkers

Review+

- frequency of meetings

questionnaire

- mandate

Interest:

- drug use, resistance rates as data

Indicators for quality of AB prescribing

- formulary as intervention

- updating formulary

- restriction/approval as intervention

- guidelines for empiric therapy, IV-PO, dosing, prophylaxis,

- rounds as intervention

- education as intervention

- guidance or assisted decision analysis via IT

13

Trivedi, Rosenberg

2013

The state of antimicrobial stewardship programs in California

Design:

- implemented or planned ASP

Survey

- time of start with ASP

Interest:

- possible stakeholders in team

State of ASP

- FTE availability

- - funding

- benchmarking as intervention

- DDDs, DOTs, costs, acceptance of recommendations, improved susceptibility patterns as data

- use of IT in ASP

- electronic health record, digital prescription, electronic medication administration records as IT

- formulary restriction as intervention

- ID physician consult as intervention

- audit as intervention

- prior approval as intervention

- auto stop orders as intervention

- verbal approval as intervention

- pre-authorization as intervention

- education as intervention

- guidelines as intervention

- IV-PO switch as intervention

- streamlining/de-escalation as intervention

     

- order forms as intervention

  1. *) DDDs: daily defined doses; DOT: days of therapy; FTE: full-time equivalent; ID: infectious diseases; IV-PO: intravenous-per os; IT: information technology.