scholarly journals Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 280
Author(s):  
Saleh Alghamdi ◽  
Ilhem Berrou ◽  
Eshtyag Bajnaid ◽  
Zoe Aslanpour ◽  
Abdul Haseeb ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Program Implementation ◽  
Multi Drug Resistance ◽  
Successful Implementation ◽  
Management Support ◽  
Structured Interviews ◽  
Program Outcomes ◽  
Implementation Phase ◽  
Stewardship Program

Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials’ use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation is the lack of knowledge of how to implement them. This study aims to explore how an antimicrobial stewardship programme was implemented in a Saudi hospital, the challenges faced and how they were overcome, and the program outcomes. A key stakeholder case study design was used, involving in-depth semi-structured interviews with the core members of the ASP team and analysis of 35 ASP hospital documents. ASP implementation followed a top-down approach and involved an initial preparatory phase and an implementation phase, requiring substantial infectious diseases and clinical pharmacy input throughout. Top management support was key to the successful implementation. ASP implementation reduced rates of multi-drug resistance and prescription of broad-spectrum antimicrobials. The implementation of ASPs in hospital is administrator rather than clinician driven. Outsourcing expertise and resources may help hospitals address the initial implementation challenges.

scholarly journals Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 470
Author(s):  
Dipu T. Sathyapalan ◽  
Jini James ◽  
Sangita Sudhir ◽  
Vrinda Nampoothiri ◽  
Praveena N. Bhaskaran ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Successful Implementation ◽  
Loading Dose ◽  
Antimicrobial Stewardship Program ◽  
Entire Study ◽  
Stewardship Program ◽  
South Indian ◽  
Implementation Period ◽  
The Right

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

Organizational Predictors of a Successful Implementation of an Ergonomic Training Program

2007 ◽  
Vol 51 (16) ◽  
pp. 967-971 ◽  
Author(s):  
Christian Korunka ◽  
Elisabeth Dudak ◽  
Martina Molnar ◽  
Peter Hoonakker
Keyword(s):  
Training Program ◽  
Single Case ◽  
Training Transfer ◽  
Successful Implementation ◽  
Management Support ◽  
Social Resistance ◽  
Large Production ◽  
Individual Variables ◽  
Production Company

Job, organizational and individual predictors of a successful implementation of an ergonomic training program are evaluated in a single case study. 116 employees in a large production company underwent a comprehensive ergonomic training. Transfer of the training into practice was measured by the number of ergonomic improvements which were realized in the company. Job, organizational and individual variables explained 35% of the variance of the training transfer. Psycho-social resistance attitudes and missing management support were found to be the most important inhibitors of implementation success.

Barriers to implementing waste-to-energy projects in Sri Lanka: a PESTEL analysis

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Binashi Kumarasiri ◽  
Piumi Dissanayake
Keyword(s):  
Sri Lanka ◽  
Expert Knowledge ◽  
Research Strategy ◽  
Waste To Energy ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Content Type ◽  
The Government ◽  
Under Construction

PurposeIt is no surprise that garbage is not garbage for some. It is money. This is why garbage has been overestimated to a point that money allocated for waste-to-energy (WtE) projects feed individual pockets. Many countries have already adapted WtE as a successful solution for both energy and waste crisis. Although in Sri Lanka six WtE projects were promised, the government abruptly decided that it would not have any more projects other than the two plants that were under construction. The purpose of this paper is to analyse barriers to the implementation of WtE projects in Sri Lanka.Design/methodology/approachAn exploratory case study was selected as the research strategy to achieve the research aim. In total, two WtE megaprojects, which have been initiated implementation in Sri Lanka, were used as cases. A total of 12 semi-structured interviews with four personnel from each case and four government officials were used as the data collection technique. Data analysis was carried out using code-based content analysis. The barriers were extracted through analysis of case findings using an abductive analysis. The strategies to mitigate identified barriers were formulated based on attributes highlighted through case study findings and further validated through the opinions of three experts.FindingsBarriers were analysed using the PESTEL framework to get ample insight into barriers that impact on the implementation of WtE projects in Sri Lanka. Less support from the government due to their less awareness on WtE, high investment and operational cost, lack of expert knowledge on WtE technologies in Sri Lanka, absence of a proper regulatory framework for implementation WtE technologies, lengthy process and delay in getting approvals from government process, poor attitudes of public and their protests due to the less awareness on WtE are the foremost barriers identified in this study. Further, strategies were proposed based on the empirical research findings to overcome barriers to facilitate the successful implementation of WtE projects in Sri Lanka.Research limitations/implicationsSo far only two WtE megaprojects have been initiated the implementation in Sri Lanka. Therefore, the scope of the study was limited only to those projects. Moreover, the type of waste considered in this study is municipal solid waste (MSW), which has become a bigger problem in Sri Lanka.Originality/valueThe current study unveils an analysis of barriers for implementation of WtE projects in Sri Lanka, including strategies for mitigating identified barriers. The findings would enable relevant stakeholders, i.e. policymakers, industry practitioners, investors, government bodies and researchers to make informed decisions on implementation of WtE projects and thereby promote successful implementation of WtE projects in Sri Lanka.

scholarly journals Impact of a multifaceted antimicrobial stewardship program: A front-line ownership driven quality improvement project in a large urban emergency department

CJEM ◽  
2017 ◽  
Vol 19 (06) ◽  
pp. 441-449 ◽  
Author(s):  
Adam Jonathan Kaufman ◽  
Janine McCready ◽  
Jeff Powis
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Inpatient Setting ◽  
Successful Implementation ◽  
Antimicrobial Use ◽  
Front Line ◽  
Improvement Project ◽  
Antibiotic Overuse ◽  
Defined Daily Doses ◽  
Stewardship Program

AbstractBackgroundAntibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such asClostridium difficile(C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers.ObjectiveTo determine whether a FLO approach to antimicrobial stewardship in the ED can alter antimicrobial usage.MethodsInterventions were driven by ED physicians and facilitated by Infectious Diseases Division physicians from the hospital’s ASP using FLO principles. Measured end points included antibiotic usage in the ED as measured by defined daily doses, and rates of urine culture sent from the ED.ResultsThere was a step-wise significant reduction in the use of azithromycin (p=0.006), ceftriaxone (p=0.045), ciprofloxacin (p=0.034), and moxifloxacin (p=0.008). There was also a significant reduction in rates of urine cultures (p<0.001) by 2.26 urine cultures per 100 ED patient visits.ConclusionsFLO offers a promising approach to successful implementation of an ASP in the ED. Future studies would be important to evaluate the generalizability of the FLO approach to ASP development in other EDs and to determine strategies to improve the sustainability of reductions in antimicrobial use.

scholarly journals Ethical and psychological factors in 5S and total productive maintenance

2017 ◽  
Vol 10 (3) ◽  
pp. 444 ◽  
Author(s):  
Jamal Ahmed Hama Kareem ◽  
Othman Abdul-Qader Hama Amin
Keyword(s):  
Questionnaire Survey ◽  
Psychological Factors ◽  
Successful Implementation ◽  
Employee Morale ◽  
Structured Interviews ◽  
Total Productive Maintenance ◽  
Theoretical Contribution ◽  
Industrial Organizations

Purpose: The purpose of this paper is to investigate the role of ethical and psychological factors in the implementation of 5S and TPM at cement plants in Kurdistan Region of Iraq.Design/methodology/approach: The mixed methods represented in a questionnaire survey and semi-structured interviews for data collection in the framework of the case study were chosen. The questionnaire survey already has been tested.Findings: The findings of this paper revealed that ethical factors had a larger role than psychological factors in the implementation. Thus, based on the findings, organisations are recommended to provide financial and moral support to employees to enable a comprehensive implementation of 5S and TPM aimed at obtaining the desired results. Originality/value: The current paper tried to introduce a new theoretical contribution by filling the gap in the literature regarding the important role that can be played by ethical and psychological factors of employees in the successful implementation of contemporary techniques, such as 5S and TPM in industrial organizations. This is contrary to what was done most of previous studies such as Ahuja & Khamba, (2008b) Panneerselvam (2012) Singh et al. (2013) and Poduval & Pramod (2015) in the area of 5S and TPM. Where, these studies have focused on studying the other factors such as (organizational, technological, operational and others) in implementing 5S and TPM. This without realizing the fact that it is also necessary to examine factors such as (ethical and psychological) that would affect the capabilities and employee morale before and during the implementation of those techniques (5S and TPM) that are used to bring out the best productivity.  

scholarly journals Evaluation of Asymptomatic Bacteruria Management Before and After Antimicrobial Stewardship Program Implementation: Retrospective Study

2021 ◽  
Author(s):  
Ahlam Alghamdi ◽  
Majed Almajed ◽  
Raneem Alalawi ◽  
Amjad Alganame ◽  
Shorooq Alanazi ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Program Implementation ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Stewardship Program ◽  
Positive Urine Culture ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Positive Urine ◽  
Before And After

Abstract BackgroundThe Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program implementation and advance towards its appropriate use. MethodWe performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥18 years old who had a positive urine culture with no signs or symptoms of urinary tract infection and were on antibiotics for asymptomatic bacteriuria. We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery.ResultsA total of 716 patients with a positive urine culture were screened . Among these, we identified 109 patients with ASB who were enrolled in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the Antimicrobial Stewardship Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = .099687). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains. ConclusionThe urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

scholarly journals A framework for the implementation of certification procedures at nurse level: a case study in a French hospital

2020 ◽  
Author(s):  
Israa SALMA ◽  
Mathias WAELLI
Keyword(s):  
Empirical Studies ◽  
Implementation Process ◽  
Local Context ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Implementation Framework ◽  
Healthcare Facilities ◽  
Definition Of ◽  
Implementation Tool

Abstract Background The implementation of certification procedures across healthcare systems is an essential component of the management process. In the past, several promising approaches have been developed towards the successful implementation of such policies, however, precise adaptation and implementation at the local context is essential. Thus, local activities must be considered to generate more pragmatic recommendations for managers. In this pilot study, we built an implementation framework for the inception of certification in healthcare facilities, particularly at nurse level activities. Our hypothesis comprised two objectives: the identification of key implementation process components, and the precise definition of these elements within local social activities. Methods This study used a two-step abductive approach. The first was inductive, and consisted of a qualitative case study, where we analysed the implementation of certification procedures in a French teaching hospital. The study was conducted between April and December 2019. Data were collected using semi-structured interviews, and observations by shadowing. In the second step, the emerging data were analysed using two approaches: The Quality Implementation Tool (QIT) and Translational Mobilisation Theory (TMT). Results Sixteen interviews were conducted with managers and nurses. We also accumulated 83 observational hours from two different wards. Our results showed that, first, all the retrieved elements over the implementation of certification procedures were captured by the QIT components and only one component was no applicable for the studied case. Second, we identified the elements in the local context of activity, with the different interrelationships between actors, actions and contexts, through the TMT. Third, our analyses were integrated and translated into a framework that described the implementation of certification procedures in healthcare facilities and with interest to the implementation at nurse/mid-managers level. In adopting QIT, the framework components took a transversal aspect then adapted to the local context of work through the TMT. Conclusions In this study, we generated an implementation framework that underpinned a certification procedures implementation. Our approach revealed broad interactions between proximity managers, teams and contexts during change mobilisation, not captured by transversal framework only as QIT. Going forward, this framework must be tested in future empirical studies.

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