Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection and Sample
2.2. Data Analysis
3. Results
3.1. Pharmacists’ Roles in the Implementation of AMS Strategies
“Pharmacists do play very important roles because we know [the] stock levels (of antibiotics), contributing factors to high usage of carbapenem and [other antibiotics], and we know the cost of each antibiotic, we know the appropriate dosing, pharmacokinetics or pharmacodynamics effects, and when it’s not justified, what to recommend, what other alternatives we have, and whether any dose adjustment [is] needed… So definitely, pharmacists [are] very important, no one can replace [them]…”(Respondent 14, university/state/major specialist hospital, 2 years of experience in AMS)
3.1.1. Pharmacists’ Diverse Functions
“…clinical pharmacists are the ones who really go into evidence-based [recommendations], and always intervene and recommend to the doctors on how to give appropriate antibiotics to all the patients according to accessibility and the local antibiogram.”(Respondent 7, university/state/major specialist hospital, 3 years of experience in AMS)
“…after the launch of our National Antibiotic Guidelines 2014, we extracted the data and divided it based on department, and then we assigned pharmacists to each department to sit down with the representatives from each department and microbiologists to go through the National Antibiotic Guidelines and see whether they agree to it or not. And if they don’t agree, to revise it based on evidence…after everyone has a consensus and agreement, we (pharmacists) compile and publish it as hospital antibiotic guidelines.”(Respondent 15, university/state/major specialist hospital, 1 year of experience in AMS)
3.1.2. Visions on Role Expansion
“…we are trying to educate the ward pharmacists that anyone can do AMS and has to do AMS every day. So, it’s not just one AMS pharmacist doing AMS-related things… it doesn’t have to be something bombastic, something big. If [it is] just a matter of dose optimization, it is [also] considered AMS.”(Respondent 15, university/state/major specialist hospital, 1 year of experience in AMS)
“Yes, I think it can be done…It is good and it does work because I think …if you really do work as a clinical pharmacist, we are more knowledgeable in antibiotics compared to doctors.”(Respondent 7, university/state/major specialist hospital, 3 years of experience in AMS)
“…our training is not the same as ID (infectious disease) physicians; they have that insight on certain pathophysiology and diagnosis… I would say for [pharmacists], we still need to be supported by ID physicians because they can help [us] to see certain different aspects… We can complement one another… I see it will be better to have a team approach.”(Respondent 5, university/state/major specialist hospital, 4 years of experience in AMS)
3.1.3. Impact of Pharmacists’ Involvement in AMS
“…by frequently having AMS rounds…the doctors [are] alert with their antibiotic orders, especially before the round, they will make sure everything is done (correctly) before we go for [the] antibiotic round.”(Respondent 16, university/state/major specialist hospital, 3 years of experience in AMS)
3.2. Barriers and Facilitators to Pharmacists’ Roles in the Implementation of AMS Strategies
3.2.1. Resources
“Our training consists of talks rather than an attachment. I think for this to be successful, every AMS pharmacist must go through specialized training… talks and real-life [or] practical is different… for example myself… I have been attending talks, I have been reading online; I have been doing some learning but I have never ever been trained in a proper manner. So, I think because of that, we are not confident enough… we cannot, like, confidently suggest anything.”(Respondent 9, minor specialist/non-specialist hospital, 1 year of experience in AMS)
“One very big barrier is we hold multiple portfolios…so basically, I have to wear different hats, to read up different things. Then, we are also involved in teaching, meetings, and certain hospital quality-based work. So, that takes up a lot of time…”(Respondent 5, university/state/major specialist hospital, 4 years of experience in AMS)
“…the IT system has simplified the screening of patients because we can screen for culture and sensitivity results at the same time and it speeds up the screening process.”(Respondent 1, university/state/major specialist hospital, 4 years of experience in AMS)
“…because [the committee] becomes part of the administrative structure… that helped to ensure that some of the work through this antimicrobial stewardship committee will be recognized as a job worth doing…”(Respondent 5, university/state/major specialist hospital, 4 years of experience in AMS)
3.2.2. Attitudes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Respondent Number | Gender | Years of Experience in AMS at Current Hospital | Current Position | Hospital Category |
---|---|---|---|---|
1 | Female | 4 years | Ward pharmacist | University/state/major specialist |
2 | Female | 1 year | Ward pharmacist | University/state/major specialist |
3 | Female | 1 year | Ward pharmacist | Minor specialist/non-specialist |
4 | Female | 4 years | Ward pharmacist | University/state/major specialist |
5 | Female | 4 years | Ward pharmacist | University/state/major specialist |
6 | Female | 2 years | Ward pharmacist | University/state/major specialist |
7 | Female | 3 years | Ward pharmacist | University/state/major specialist |
8 | Female | 3 years | Ward pharmacist | Minor specialist/non-specialist |
9 | Male | 1 year | Ward pharmacist | Minor specialist/non-specialist |
10 | Female | 1 year | Ward pharmacist | University/state/major specialist |
11 | Female | 1 year | Ward pharmacist | University/state/major specialist |
12 | Female | 3 years | Ward pharmacist | University/state/major specialist |
13 | Female | 1 year | Ward pharmacist | Minor specialist/non-specialist |
14 | Female | 2 years | Ward pharmacist | University/state/major specialist |
15 | Female | 1 year | Ward pharmacist | University/state/major specialist |
16 | Male | 3 years | Ward pharmacist | University/state/major specialist |
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Lai, W.M.; Islahudin, F.H.; Ambaras Khan, R.; Chong, W.W. Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia. Antibiotics 2022, 11, 219. https://doi.org/10.3390/antibiotics11020219
Lai WM, Islahudin FH, Ambaras Khan R, Chong WW. Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia. Antibiotics. 2022; 11(2):219. https://doi.org/10.3390/antibiotics11020219
Chicago/Turabian StyleLai, Wan Mae, Farida Hanim Islahudin, Rahela Ambaras Khan, and Wei Wen Chong. 2022. "Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia" Antibiotics 11, no. 2: 219. https://doi.org/10.3390/antibiotics11020219
APA StyleLai, W. M., Islahudin, F. H., Ambaras Khan, R., & Chong, W. W. (2022). Pharmacists’ Perspectives of Their Roles in Antimicrobial Stewardship: A Qualitative Study among Hospital Pharmacists in Malaysia. Antibiotics, 11(2), 219. https://doi.org/10.3390/antibiotics11020219