Highlights
- •The ORCA survey measures organizational readiness to implement best practices.
- •We used the ORCA to measure barriers to an antibiotic stewardship intervention.
- •Providers had strong buy-in to the evidence for managing asymptomatic bacteriuria.
- •Inadequate resources and support were cited as barriers to stewardship.
Background
Prior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria
(ASB), we assessed institutional barriers to change using the Organizational Readiness
to Change Assessment.
Methods
Surveys were self-administered on paper in inpatient medicine and long-term care units
at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists.
The survey included 7 subscales: evidence (perceived strength of evidence) and six
context subscales (favorability of organizational context). Responses were scored
on a 5-point Likert-type scale.
Results
One hundred four surveys were completed (response rate = 69.3%). Overall, the evidence
subscale had the highest score; the resources subscale (mean 2.8) was significantly
lower than other subscales (P < .001). Scores for budget and staffing resources were lower than scores for training
and facility resources (P < .001 for both). Pharmacists had lower scores than providers for the staff culture
subscale (P = .04). The site with the lowest scores for resources (mean 2.4) also had lower scores
for leadership and lower pharmacist effort devoted to stewardship.
Conclusions
Although healthcare professionals endorsed the evidence about nontreatment of ASB,
perceived barriers to antibiotic stewardship included inadequate resources and leadership
support. These findings provide targets for tailoring the stewardship intervention
to maximize success.
Key Words
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Article info
Publication history
Published online: May 10, 2020
Footnotes
Conflicts of interest: Dr. Trautner reports grants from VA HSR&D, during the conduct of the study; grants from NIH, AHRQ, CDC, grants and personal fees from Zambon pharamceuticals, personal fees from Paratek pharmaceuticals, outside the submitted work. Dr. Grigoryan reports grants from NIH, AHRQ, VA HSR& D, grants from Zambon Pharmaceuticals, grants from Rebiotix, outside the submitted work.
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© 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
