Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study

ObjectivesTo determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.Setting1300-bed tertiary care private hospital located in the state of Kerala, India.Participants31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.ResultsKey facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.ConclusionsOpportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.

Psychological Approaches for Overturning an Immunity to Change

In this article, Deborah Helsing shows how practitioners in the helping professions—whether they be coaches, facilitators, educators, or counselors—can increase their own capacity to be effective by employing the Immunity to Change (ITC) process, a methodology for growth and change that allows practitioners to incorporate insights from a variety of psychological theories into one instrument and process. Helsing highlights the theory that underpins ITC, illustrating how it operates as a meta-theory that draws from different psychological traditions. She then goes on to show how even a rudimentary knowledge of these traditions provides possibilities for exploring what might be at the heart of a psychological immune system, thus increasing the chances that users will arrive at an accurate and perceptive diagnosis that leads to a transformational result. In her essay she argues that ITC practitioners who can integrate multiple theoretical approaches can more flexibly and powerfully address the learning needs of those they seek to help.