Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review

Journal of the American Board of Family Medicine: JABFM

Heather Sateia^1¹  Julie Szymczak^1²  Sara E. Cosgrove^1³  Pranita D. Tamma^1⁴  Melissa A. Miller^1⁵  Sara C. Keller^1⁶ 

[1] Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore (SCK, SEC, APG);Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (JAL)^1;Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore (HS);Division of Healthcare-Associated Infections, Agency for Healthcare Research and Quality, Rockville (MAM);University of Pennsylvania Perelman School of Medicine, Philadelphia (JS);From Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD (SCK, PDT, SEC)

关键词: Antibiotics;    Antimicrobial Stewardship;    Clinical Decision Support Systems;    Patient Safety;    Point-of-Care Testing;    Quality Improvement;   

DOI  :  10.3122/jabfm.2018.03.170225

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Introduction: In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. Methods: We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Results: Of 1,288 s initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. Conclusions: A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS.

【 授权许可】

CC BY