Format

Send to

Choose Destination
See comment in PubMed Commons below
Clin Infect Dis. 2013 Jul;57(2):188-96. doi: 10.1093/cid/cit212. Epub 2013 Apr 9.

Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".

Author information

1
The National Centre for Infection Prevention and Management, Imperial College London, 2nd Floor, Hammersmith House, Du Cane Road, London W12 OHS, UK. e.charani@imperial.ac.uk

Abstract

BACKGROUND:

There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs.

METHODS:

Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 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 behaviors.

RESULTS:

The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior 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 that 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 "noninterference" 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.

KEYWORDS:

antimicrobial prescribing; prescribing behavior; prescribing etiquette

PMID:
23572483
PMCID:
PMC3689346
DOI:
10.1093/cid/cit212
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Support Center