Nationwide audit and feedback on implementation of antibiotic stewardship programmes in Norwegian hospitals

Abstract

Background: Implementation of antibiotic stewardship programmes (ASPs) in hospitals is challenging and there is a knowledge gap on how to pursue this process efficiently.

Objectives: To evaluate whether audit and feedback (A&F) is a feasible and useful methodology to assess and support the implementation of ASPs in hospitals.

Methods: A multidisciplinary team performed document reviews and on-site interviews with professionals involved in the implementation of ASPs. Oral feedback on preliminary findings and areas of improvement were provided on-site, followed by feedback reports summarizing major findings and recommendations. Descriptive statistics were used to present number of hospital trusts, interviewees, professions, disciplines, workload and costs.

Results: All 22 hospital trusts in Norway participated in the A&F conducted October 2017 to April 2019. Altogether, 446 leaders and healthcare workers were interviewed: 110 leaders, 336 health professionals of whom 89 were antimicrobial stewardship team members. Median number of days from audits were performed till reporting were 36 (IQR 30-49). Median workload for auditors per visit was 7 days (6-8). Total costs were €133 952. Main audit findings were that ASP structures were established in most hospital trusts, but leadership commitment and implementation of interventions were often lacking. The hospital trusts received feedback on establishing governance structures, setting local targets, implementing interventions and increased involvement of nurses.

Conclusions: Nationwide A&F provides a unique and comprehensive insight into the implementation of ASPs in hospitals and is feasible with a reasonable amount of resources. This approach can identify targets for improved implementation of ASPs in hospitals.

Figure 1.

Interviewed health professionals (n = 247) and their affiliation.

Figure 2.

Interviewed members of antimicrobial stewardship teams and their affiliation (n = 89).

Figure 3.

The timeline for the audit and feedback. Letter and number correspond to when the hospital trusts in each regional health trust were visited/audited. Length of box corresponds to time from on-site visit till report/feedback was finalized. N, Northern Regional Health Trust (4 hospital trusts); W, Western Regional Health Trust (5 hospital trusts); C, Central Regional Health Trust (3 hospital trusts); SE, South-Eastern Regional Health Trust (10 hospital trusts).