Eliciting the barriers and enablers towards anaesthetists giving penicillin-based antibiotic prophylaxis to low-risk patients who have had their penicillin allergy label removed as part of a preoperative delabelling process.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-05-13 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae062
Neil Roberts, Libby Fontaine, Jonathan Sandoe, Sarah Tonkin-Crine, Neil Powell
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Abstract

Background: Some penicillin allergy labels can be removed by non-allergy specialists by direct oral challenge, but there is reluctance amongst anaesthetists to give penicillin to these patients. We aimed to assess anaesthetist beliefs about giving penicillin to patients delabelled by direct oral challenge.

Methods: A survey, developed using the Theoretical Domains Framework, was circulated to anaesthetists within a regional research network in England. Domains were rated using 5-point Likert scales. Overall and group medians were used to dichotomize domains rated by group into 'relatively important/unimportant' and 'relative enabler/barrier'.

Results: We received 257 responses from six hospitals (response rate 49.7%). Seven domains were rated as important for all stakeholder groups and hospitals: Knowledge, Skills, Belief in Capabilities, Belief in Consequences, Memory/Attention/Decisions, Environmental Context and Resources, and Emotions. Social and Professional Role was also important to all respondents except those in one hospital. Intentions and Optimism were rated as important for some groups/hospitals and unimportant for others. All four other domains were rated as unimportant for all groups/hospitals. All domains rated as important were enablers for all groups/hospitals, with the exception of Memory/Attention/Decisions and Emotions, which were rated as discordant barriers/enablers between groups. This means they were acting as a barrier for some staff groups/hospitals and an enabler for others. Barrier domains (Reinforcement, Goals, Social Influences, Behavioural Regulation) were all rated unimportant.

Conclusions: Behavioural influences on giving penicillin prophylaxis to a delabelled patient are complex and nuanced. These findings could inform targeted interventions, both across and within hospitals and staff groups.

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了解麻醉师在术前去除青霉素过敏标签的过程中,为低风险患者提供青霉素类抗生素预防的障碍和促进因素。
背景:一些青霉素过敏标签可由非过敏专家通过直接口服挑战去除,但麻醉师不愿意给这些患者使用青霉素。我们的目的是评估麻醉师对给通过直接口服挑战去除过敏标签的患者注射青霉素的看法:方法:我们向英格兰地区研究网络内的麻醉师分发了一份采用理论领域框架制定的调查问卷。采用 5 点李克特量表对各领域进行评分。使用总体和组别中值将各组别评定的领域分为 "相对重要/不重要 "和 "相对有利/有碍 "两类:我们收到了来自六家医院的 257 份回复(回复率为 49.7%)。对所有利益相关群体和医院而言,有七个领域被评为重要领域:知识、技能、能力信念、后果信念、记忆/注意力/决策、环境背景和资源以及情感。除一家医院外,社会和职业角色对所有受访者都很重要。意向和乐观对某些群体/医院来说很重要,而对其他群体/医院来说则不重要。所有其他四个领域对所有群体/医院来说都不重要。所有被评为重要的领域对所有组别/医院来说都是促进因素,但记忆/注意力/决定和情感除外,这两个领域在不同组别之间被评为不一致的障碍/促进因素。这意味着它们对某些员工群体/医院来说是障碍,而对其他员工群体/医院来说则是促进因素。障碍领域(强化、目标、社会影响、行为调节)均被评为不重要:给被取消标签的病人注射青霉素预防针的行为影响因素复杂而微妙。这些发现可以为医院和员工群体之间以及医院和员工群体内部有针对性的干预措施提供依据。
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