Abstract Background Inappropriate treatment of bacteriuria is commonly reported. While evidence to support antimicrobial stewardship (AMS) interventions has been published, few studies justify intervention components or incorporate theory into designing interventions. The objective of the study was to develop a theory-informed multifaceted AMS intervention to improve management of bacteriuria in adults admitted to hospital. Methods We used the 4-step approach described by French and colleagues to develop a theory informed intervention. A systematic review of AMS interventions to improve antibiotic use for bacteriuria was completed. In addition, local barriers to improving antimicrobial use in hospitalized adults with bacteriuria were assessed through a qualitative study using focus groups with health care providers. Barriers identified through the qualitative study were mapped to the Theoretical Domains Framework and the COM-B model then linked to the Behaviour Change Wheel. Published literature, focus group results, and practical considerations were used by our team to identify and rank possible solutions. Consensus on which interventions to implement locally was achieved using the Nominal Group Technique. Results Ten interventions that could address local challenges with antimicrobial prescribing for bacteriuria were identified. The highest-ranking interventions were audit and feedback (to individuals or teams), active educational sessions, development of clinical order sets, and incorporating clinical decision support with culture results. A multifaceted intervention that included monthly audit and feedback on management of bacteriuria to multidisciplinary teams in combination with case-based virtual education sessions was developed and is currently being piloted at four tertiary and community hospitals. Conclusion Use of theory to identify local barriers and facilitators to improving antimicrobial use in combination with evidence and practical considerations should be incorporated into design and implementation of AMS interventions. Further work will evaluate impact of this theory-informed AMS intervention on antimicrobial prescribing for bacteriuria in hospitalized adults. Disclosures Emily Black, BSc(Pharm), PharmD, Drug Evaluation Alliance of Nova Scotia: Grant/Research Support|Research Nova Scotia: Grant/Research Support Paul Bonnar, MD, BioMerieux: Honoraria|Paladin Labs: Honoraria Samuel G. Campbell, FRCP (Edin), Astra Zeneca: Board Member
Présenter une approche pour évaluer les risques d’urgences dans sa propre clinique médicale, et déterminer le matériel et les médicaments nécessaires pour de telles urgences, de même que la formation du personnel requise pour aborder cette importante facette des soins aux patients. SOURCES DE L’INFORMATION: Les recommandations sur la préparation aux urgences dans cet article se fondent sur des données colligées à partir de plans de préparation aux urgences déjà existants chez les médecins de famille, d’une évaluation formelle faite par des médecins et d’une rétroaction informelle fournie à la suite de 2 présentations à de grands groupes, de même que sur l’expertise des auteurs dans des domaines comme la médecine familiale, la médecine d’urgence, les soins préhospitaliers et la pharmacologie.La définition des risques en fonction du profil, de l’emplacement et des caractéristiques démographiques de la pratique éclairera l’élaboration d’un plan approprié pour répondre à la fois aux attentes de la population et aux obligations professionnelles. La révision du plan ou un exercice d’entraînement une fois qu’il est élaboré améliorera le processus dans l’éventualité d’une urgence. Il est aussi essentiel de vérifier périodiquement les dates de péremption des médicaments et le bon fonctionnement du matériel.À un moment ou l’autre, les médecins auront à faire face à des urgences à leur clinique. Une évaluation des risques, une planification et un état de préparation appropriés leur permettront de fournir des soins de grande qualité, d’assurer la sécurité de leur personnel, d’obtenir les meilleurs résultats pour les patients et de ressentir la satisfaction d’avoir géré un problème urgent d’une manière efficiente et efficace.
This essay includes a brief history of women in medicine and the challenges they have encountered in developing mentoring relationships. We have provided some observations from peers and of our own, on women physicians and women working in medicine at different stages of their lives and careers, and the need for vigilance and assertiveness. Family responsibilities often interfere with career goals and mentors can play a key role in strategic career management at these times. The importance of strong role models and mentors for all professionals is increasingly documented. Some tips are provided to help reduce the challenges encountered in building strong relationships with suitable mentors.
The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, practice facilitation, which is a common strategy in primary care to help practices develop capacity and infrastructure to support their ability to improve patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe practice facilitation, its terminology, and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report practice facilitation efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of practice facilitation.
Actively addressing racism in our faculties of medicine is needed now, more than ever. One way to do this is through allyship, the practice of unlearning and re-evaluating, in which a person in a position of privilege and power seeks to operate in solidarity with a traditionally marginalized group. In this paper, we provide practical tips on how to practice allyship, giving educators and leaders background understanding and important tools on how to actively promote equity and diversity. We also share tips on how to promote inclusivity to more accurately reflect the communities we serve. Through six broad actions of being, knowing, feeling, doing, promoting, and acting, we can empower individuals to become allies and address racism in medical education and beyond. Creating psychologically safe spaces, educating ourselves on our complex histories and how they influence the present, recognizing racism, and advocating for change, augments awareness from which we can pivot conversations. Acknowledging potential feelings of shame, guilt, and embracing our loss of privilege, allow necessary, but challenging, personal growth to occur. Finally, dismantling the racist structures that exist within medicine, moving us beyond individual interventions, will address the systemic nature of racism in medicine. Everyone can find a starting place within this guide, as simple, consistent actions foster change in our spheres of influence; and the ripple effect of these changes will impact attitudes and behaviours broadly.
The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, to standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, performance measurement and feedback, which is a common intervention in health professions education. In the form of a summary report, performance measurement and feedback is an opportunity for clinicians to view data about the care they provide compared with some standard and often with peer and benchmark comparisons. Based on a review of recent evidence and a facilitated discussion with the US and Canadian experts, we describe proper terminology for performance measurement and feedback and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report efforts with performance measurement and feedback. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of performance measurement and feedback.
