Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

, INHALE WP2 Study Group (2021) Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework. BMJ Quality and Safety. ISSN 2044-5415

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Abstract

Background: Antibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing. Methods: We conducted four focus groups and 34 semi-structured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework. Results: Clinicians’ antibiotic decisions were influenced by their judgment of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of under-treatment.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 27 May 2021 00:09
Last Modified: 16 Jun 2021 00:19
URI: https://ueaeprints.uea.ac.uk/id/eprint/80119
DOI: 10.1136/bmjqs-2020-012479

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