Identifying Opportunities for Antimicrobial Stewardship in a Tertiary Intensive Care Unit: A Qualitative Study

Background: Antimicrobial stewardship (AMS) encompasses numerous interventions that seek to improve antimicrobial usage, as inappropriate use of antimicrobials may result in the promotion of antimicrobial resistance, patient harm, and increased costs. AMS is of particular interest in intensive care units (ICUs) where antimicrobial use is extensive. Few qualitative studies have sought to identify the perceived attitudes and beliefs of intensive care clinicians around AMS. Objectives: To understand ICU nursing and physician priorities and preferences around AMS and possible AMS interventions for implementation in the ICU. Methods: Using consecutive sampling, semi-structured one-to-one interviews were conducted with ICU nursing and physician staff at a tertiary hospital in BC, Canada. Results: Nine participants (seven nurses and two physicians) were interviewed, and themes were identified and categorized as: opportunities to improve AMS in the ICU, barriers to AMS in the ICU, and possible future AMS interventions for implementation in the ICU. Opportunities identified included: clinician activities (improved communication, de-escalation, ICU nurse assessment) and support (infectious disease and antibiotic experts, AMS presence). Barriers identified included: knowledge gaps (infectious disease and antibiotic knowledge, AMS awareness), AMS and ICU integration (nursing role in AMS, AMS efficacy in ICU), and environment (competing priorities, critical care context). Interventions identified included: organisational (EMR modifications, checklists, algorithms), learning (infectious disease and antimicrobial education, audit, and feedback), and nursing intervention (antibiotic review, prompting reassessment).