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Model answer

Identifying perceived barriers in the outbreak meeting: model answers

The author’s model answer and summary below:

1. The antimicrobial management lead (AML) discussed perceived beliefs about the consequences of the use of specific antibiotic agents held by medical staff.
a) Reportedly, urologists disagree with the national recommendation to restrict the use of cephalosporins and ciprofloxacin as they consider it to be very useful for very sick patients, while the antibiotic agents recommended by the national guideline were felt to not be effective enough.
b) Seemingly, urologists and anaesthetists, in contrast to the national antibiotic guideline, considered Tazocin as the best from of prophylaxis and regarded gentamicin harmful.
c) The use of antibiotics in ways other than specified by the local antibiotic policy was viewed by a consultant urologist as not associated with adverse events.
2. The AML further delineated how resultant resistance from medical staff acted as a barrier to development and implementation of the local antibiotic policy, that was aligned with the national antibiotic policy. The antimicrobial pharmacist also perceived that medical staff’s resistance hinders implementation of antibiotic policy. The medical director (MD) even expressed concerns about the content and compliance with the local antibiotic policy.
a) Resistance from urologists to support recommendations of the national guideline on types of antibiotic agents to be used led AML to abandon efforts to include urologists in the development of the local antibiotic policy, which acted as a barrier to developing an optimised local antibiotic policy.
b) According to the AML, resistance from medical staff further resulted in poor overall compliance (an estimated 30% [on a scale from 0% (none) to 100% (perfect) compliance with the policy]) with the local antibiotic policy, and this was not much better for the prophylaxis recommendations specifically.
3. According to the AML, the clinical director and one of the attending surgeons were too busy to attend the meeting to discuss prescribing issues. The MD expressed concern about this fact, suggesting that he viewed it as a barrier to optimising implementation of the local antibiotic policy.
4. The AML also reported that the exact rate of non-compliance with guidelines was unclear, as monitoring of antibiotic use in general is hindered by the lack of means to measure it continuously and use of prophylaxis, specifically due to lack of cooperation from medical staff on wards.

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Utilising Social Science and Behaviour Change in Antimicrobial Stewardship Programmes: Improving Healthcare