RT Journal Article
SR Electronic
T1 Assessing feasibility of establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e053343
DO 10.1136/bmjopen-2021-053343
VO 11
IS 10
A1 Vu Thi Lan Huong
A1 Ta Thi Dieu Ngan
A1 Huynh Phuong Thao
A1 Le Minh Quang
A1 Tran Thi Thu Hanh
A1 Nguyen Thi Hien
A1 Tran Duc
A1 Vu Hai Vinh
A1 Chau Minh Duc
A1 Vo Thi Hoang Dung Em
A1 Phan Van Be Bay
A1 Nguyen Thi Thuy Oanh
A1 Pham Thi Thuy Hang
A1 Nguyen Thi Cam Tu
A1 Truong Anh Quan
A1 Thomas Kesteman
A1 Elizabeth Dodds Ashley
A1 Deverick Anderson
A1 H Rogier van Doorn
YR 2021
UL http://bmjopen.bmj.com/content/11/10/e053343.abstract
AB Objectives To investigate the feasibility of establishing hospital-based antimicrobial stewardship (AMS) programmes comprising action-planning, educational interventions and data feedback in two provincial-level hospitals in Viet Nam.Design and setting This was an implementation research using participatory action process and existing resources from the Duke Antimicrobial Stewardship Outreach Network with local adjustments. A national stakeholder meeting and Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis were conducted to identify gaps and potential interventions.Participants Hospital AMS staff implemented activities throughout the study phases. Routinely collected patient data were analysed to support planning, implementation and evaluation.Interventions Hospitals were considered as a complex adaptive system and leveraged their unique characteristics and interconnections to develop 1-year plans containing core interventions (data use, educational training, prospective audit with feedback (PAF) and evaluations).Outcome measures We assessed feasibility using outputs from stakeholder meeting, SWOT analysis, baseline data, planning process and implementation.Results The stakeholder meeting identified three gaps for AMS at national level: supportive policies, AMS training and core competencies and collaboration. At the hospitals, AMS programmes took 1 year for planning due to lack of hospital-specific procedures and relevant staff competencies. Baseline data (January–December 2019) showed variations in antibiotic consumption: 951 days of therapy (DOT) per 1000 days present in the control and 496 in the intervention wards in hospital 1, and 737 and 714 in hospital 2, respectively. During 1-year implementation, clinical pharmacists audited 1890 antibiotic prescriptions in hospital 1 (June 2020–May 2021) and 1628 in hospital 2 (July 2020–July 2021), and will continue PAF in their daily work.Conclusion Our data confirmed the need to contextualise AMS programmes in low-income and middle-income countries (LMICs) and demonstrated the usefulness of implementation research design in assessing programme feasibility. Developing staff competencies, using local data to stimulate actions and integrating programme activities in routine hospital work are key to success in LMICs.All data relevant to the study are included in the article or uploaded as supplementary information. Summary data from this study could be made available upon reasonable request.