Abstract
Aim : To examine and understand the work processes of AMS teams
across two hospitals that use the same digital intervention, and to
identify the challenges and enablers to effective AMS in each setting.
Methods : Employing a contextual inquiry approach informed by
the Systems Engineering Initiative for Patient Safety (SEIPS) model,
observations and semi-structured interviews were conducted with AMS team
members (n=15) in two Australian hospitals. Qualitative data analysis
was conducted, mapping themes to the SEIPS model.
Results : Both hospitals utilised similar systems, however, they
displayed variations in AMS processes, particularly in post-prescription
review, interdepartmental AMS meetings, and the utilisation of digital
tools. An antimicrobial dashboard was available at both hospitals but
was utilised more at the hospital where the AMS team members were
involved in the dashboard’s development, and there were user champions.
At the hospital where the dashboard was utilised less, participants were
unaware of key features, and interoperability issues were observed.
Establishing strong relationships between the AMS team and prescribers
emerged as key to effective AMS at both hospitals. However,
organisational and cultural differences were found, with one hospital
reporting insufficient support from executive leadership, increased
prescriber autonomy, and resource constraints.
Conclusion : Organisational and cultural elements, such as
executive support, resource allocation, and interdepartmental
relationships, played a crucial role in achieving AMS goals. System
interoperability and user champions further promoted the adoption of
digital tools, potentially improving AMS outcomes through increased user
engagement and acceptance.