"What if the patient has a severe reaction, and it is my fault?" A qualitative study exploring factors for sustainable implementation of penicillin allergy delabelling.

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES Antimicrobial Resistance and Infection Control Pub Date : 2024-09-02 DOI:10.1186/s13756-024-01456-8

Marie Bjørbak Alnæs, Brita Skodvin, Jan Anker Jahnsen, Grete Kalleklev Velure, Oddvar Oppegaard, Bård Reiakvam Kittang, Torgeir Storaas, Margrethe Aase Schaufel

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Abstract

Background: Penicillin allergy delabelling (PAD), the process of evaluating penicillin allergy labels, is a key target in antibiotic stewardship, but uptake of the procedure outside clinical studies is limited. We aimed to explore factors that need to be addressed to sustainably implement a clinical pathway for PAD.

Methods: We conducted a qualitative study based on semi-structured interviews with focus groups consisting of a purposive sample of twenty-five nurses and physicians working in four different hospitals in Western Norway. Systematic text condensation was applied for analysis.

Results: Psychological safety was reported as crucial for clinicians to perform PAD. A narrative of uncertainty and anticipated negative outcomes were negatively associated with PAD performance. Education, guidelines, and colleague- and leadership support could together create psychological safety and empower health personnel to perform PAD. Key factors for sustainable implementation of PAD were facilitating the informant's profound motivation for providing optimal health care and for reducing antimicrobial resistance. Informants were motivated by the prospect of a simplified PAD procedure. We identified three main needs for implementation of PAD: (1) creating psychological safety; (2) utilising clinicians' inherent motivation and (3) optimal organisational structures.

Conclusion: A planned implementation of PAD must acknowledge clinicians' need for psychological safety and aid reassurance through training, leadership, and guidelines. To implement PAD as an everyday practice it must be minimally disruptive and provide a contextually adaptive logistic chain. Also, the clinician's motivation for providing the best possible healthcare should be utilised to aid implementation. The results of this study will aid sustainable implementation of PAD in Norway.

Ethics: The study was approved by the Western Norway Regional Committee for Medical Research Ethics (Study No:199210).

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"如果病人出现严重反应，而这是我的错，怎么办？一项定性研究，探索青霉素过敏标签可持续实施的因素。

背景：青霉素过敏脱标（PAD）是对青霉素过敏标签进行评估的过程，是抗生素管理的一个关键目标，但在临床研究之外对该过程的采用却很有限。我们旨在探讨可持续实施 PAD 临床路径所需注意的因素：我们在半结构化访谈的基础上进行了一项定性研究，对挪威西部四家不同医院的 25 名护士和医生进行了有目的的抽样调查，并组成了焦点小组。研究采用了系统的文本压缩分析方法：结果：据报告，心理安全对临床医生实施 PAD 至关重要。关于不确定性和预期负面结果的叙述与 PAD 的执行呈负相关。教育、指南以及同事和领导的支持可以共同创造心理安全，增强医务人员执行 PAD 的能力。可持续实施 PAD 的关键因素是促进信息提供者提供最佳医疗保健和减少抗菌药物耐药性的深刻动机。简化 PAD 程序的前景激发了信息提供者的积极性。我们确定了实施 PAD 的三大需求：(1) 创造心理安全；(2) 利用临床医生的内在动力；(3) 优化组织结构：结论：有计划地实施 PAD 必须承认临床医生对心理安全的需求，并通过培训、领导力和指导方针来帮助确保心理安全。要将 PAD 作为日常实践来实施，就必须将其破坏性降到最低，并提供一个适应环境的物流链。此外，还应该利用临床医生提供最佳医疗服务的动机来帮助实施。这项研究的结果将有助于挪威可持续地实施PAD：本研究获得了挪威西部地区医学研究伦理委员会的批准（研究编号：199210）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

9.70

自引率

3.60%

发文量

140

审稿时长

13 weeks

期刊介绍： Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.