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Table 3 Perceptions of implementation of antimicrobial stewardship from different healthcare providers’ perspectives

From: Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

Themes Representative quotes from different healthcare providers’ perspectives
  GPs Nurses Pharmacists
Attitude towards AMS interventions Q1. “[We know] that the resistant organisms are becoming more and more of a bigger problem. And our aged care group have got an increased incidence of side effects from the antibiotics, and it's not uncommon for us to end up with someone with diarrhoea for example plus or minus Clostridium difficile colitis. So you know, thrush is a big problem in this sector as well through antimicrobials. So there are lots of reasons why we should try to adhere to the best practice.” (GP 14, 27 yr) Q2. “Yes, I think it’s certainly applicable and I think it’s been identified that we need to improve our practice. We would be prepared to do some sort of a follow-up project…” (Executive nurse 4, 12 yr) Q5. “It [Antimicrobial stewardship] is needed…In most cases, the registered nurses, or the enrolled nurses, cannot make a decision about whether an antibiotic is needed or not.” (Consultant pharmacist 5, 12 yr)
Q3. “It would be good, so only right antibiotics being used and only [prescribed to] the right resident. Only residents really need to be given [antibiotics] rather than things like behaviour change is [presumed to be] UTI and give antibiotics.” (NUM 4, 20 yr) Q6 . “I think it’s fantastic because the next step, aged care, is like a hospital or if you wanted to say that, where they are in a controlled environment where their medications are, you know, freely given but they are [supposed to be] given to them accordingly.” (Community Pharmacist 4, 4 yr)
Q4. “To be honest many of us don’t think we are overusing antibiotics in cases where it might be over using antibiotics…So if you want to change it you should be teaching and educating us.” (RN 7, 2 yr)
Perceived barriers and facilitators Q7. “I think that there is always the question of … doctor autonomy, you know, that doctors like to be their own boss, don’t like to be dictated to.” (GP 8, 20 yr) Q9. “In residential aged care there's a burden of workload, a burden of lots of things, documentation etc., so there's always a risk of ‘oh this is just another thing’.” (Executive nurse 2, 4.5 yr) Q13. “So obviously in hospital setting it’s a bit more intimate because the doctors and the pharmacists are liaising with one another quite frequently as opposed to a community pharmacist and the aged care doctors.” (Community pharmacist 4, 4 yr)
Q8. “There's too many people [GPs] dabbling…So I think if we got more people doing [full-time] aged care, or having more residents in the one facility, a lot of these problems within residential care will diminish, because you’ll get more consistent treatments.” (GP 14, 27 yr) Q10. “So GPs [are] in their own practices, they have their own perhaps ways of doing things… that may present some barriers to introducing something like that…” (NUM 1, 13 yr) Q14. “I’d be more than happy to use resources that you provide on you know best practice, guidelines, whatever, and then educate [nursing] staff. I mean I would have no problem in that and yes there is a role.” (Consultant pharmacist 6, 12 yr)
Q11. “What we’ve found in the past with other similar things is to have a champion, where we have a couple of people trained up who drive the program, and bring their peers on board if you like.” (Executive nurse 3, 10 yr)  
   Q12. “Obviously all the parties need to have that education…we need to get it across to everyone, so I think nursing staff are the best people to do that, to go up and to go down at the same time. (NUM 8, 12 yr)  
  1. Note. Q = quotes extracted from interview transcripts; GP = general practitioner; NUM = nurse unit managers; RN = registered nurse.