Introduction
Antimicrobial stewardship (AMS) programs in hospitals serve as a
critical link between effective infection management, healthcare
quality, and patient safety. As the overuse and misuse of antimicrobials
increase resistance, implementing effective strategies to optimise
antimicrobial use has become imperative.1 Hospital AMS
programs aim to promote the responsible and judicious use of
antimicrobial agents, ensuring that patients receive the right
medication at the right dose and duration. These programs use a
multidisciplinary team of specialised doctors and pharmacists to
implement guidelines, education and training initiatives,
post-prescription audit and feedback, and point-of-care
interventions.2
Antimicrobial prescribing in hospitals is unique in that while
prescribers have autonomy over their patient’s treatment, AMS teams
provide oversight. One significant challenge is the need to overcome
ingrained prescribing practices, such as decision-making based on
clinical intuition rather than evidence-based
guidelines.3,4 Additionally, striking a balance
between optimising antimicrobial use and ensuring timely treatment for
critically ill patients can be challenging. Delayed initiation of
appropriate therapy can pose risks for patients with severe
infections.5,6 AMS programs must navigate these
challenges, integrating education, feedback, and collaboration to
achieve optimal outcomes while minimising potential negative impacts.
The digitisation of hospitals, including the implementation of
electronic health records and electronic medication management systems
(eMMS), has the potential to optimise AMS programs.7Digital platforms can integrate clinical decision support systems that
offer evidence-based guidelines and recommendations at the point of
care, helping clinicians select the most appropriate antimicrobial
agent, dose, and duration. However, implementation of digital
interventions is complex. While digital interventions have the potential
to enhance AMS, they are not automatically accepted and used by
clinicians.8 A systematic review of health technology
implementation in hospitals found that even when different hospitals
adopt the same systems, contextual factors influence
utilisation.9 Therefore, understanding the contextual
factors influencing AMS work can provide insight into how technology is
utilised and how AMS programs can be optimised. The objective of this
study was 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.
We hoped that identifying factors that impact use of technology, and
effective AMS more broadly, would be of value to other organisations
implementing or evaluating their AMS programs.