title: Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative study.
abstract: BACKGROUND
  Many hospitals have implemented antimicrobial stewardship programs (ASPs) and have included in their programs strategies such as prior authorization and audit and feedback. However there are few data concerning the facilitators and barriers that ASPs face when implementing their strategies. We conducted a qualitative study to discern factors that lead to successful uptake of ASP strategies.
  
  
  METHODS
  Semistructured telephone interviews were conducted from June-July 2013 with 15 ASP member pharmacists and 6 physicians representing 21 unique academic medical centers.
  
  
  RESULTS
  Successful implementation of ASP strategies was found to be related to communication style, types of relationships formed between the ASP and non-ASP personnel, and conflict management. Success was also influenced by the availability of resources in the form of adequate personnel, health information technology personnel and infrastructure, and the ability to generate and analyze ASP-specific data. Types of effective strategies commonly cited included audit and feedback; prior authorization, especially with an educative component; and use of real-time alert technology and guidelines.
  
  
  CONCLUSIONS
  Several factors may influence ASP success in the implementation of their strategies. ASP members may use these findings to improve upon the success of their programs.
authors.affiliation: Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA. Electronic address: apakyz@vcu.edu.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Pakyz
authors.affiliation: Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA.
authors.forename: Leticia R
authors.initials: LR
authors.lastname: Moczygemba
authors.affiliation: Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: VanderWielen
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stevens
authors.affiliation: Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Kuzel
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D003625:Data Collection; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*
keywords: Audit and feedback; Prior authorization