Table 2 Summary of reported enablers
Author (year) and country | Study design and population | TDF Domain | Description of reported enablers |
|---|---|---|---|
Brink et al. (2017) [41] South Africa | Quasi-experimental (pre-post) | Behavioural regulation | Audit and feedback: - Employment of pharmacists to implement an audit and feedback model in relation to adhering to guidelines; providing feedback in written and verbal form - Benchmarking between hospitals and regions via comparative tables and graphs to compare and contrast results |
Pharmacists Surgeons Anaesthetists Theatre and surgical ward nurses Hospital, pharmacy, nursing and theatre managers | Environmental context and resources | Effective communication: - Ensuring appropriate communication between multidisciplinary parties | |
Skills | |||
Social/professional role and identity | Role delegation: - Anaesthetists taking responsibility for antibiotic administration | ||
Bryson et al. (2015) [42] UK | Quasi-experimental (pre-post) | Knowledge | Guideline dissemination: - Dissemination of information through the use of advertising and educational programs such as announcements on the intranet, displaying posters in theatre, sending out information via email as well as verbally |
Orthopaedic surgeons Anaesthetists | Environmental context and resources | ||
Cameron et al. (2015) [43] UK | Quasi-experimental (pre-post), Quantitative descriptive | Knowledge | Guideline dissemination: - Guideline availability in theatre to help with decision making - Guidelines presented in a simple ‘traffic light system’ format |
Consultant general surgeons Anaesthetists | Environmental context and resources | ||
Carlès et al. (2006) [44] France | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - Use of personalised SAP kits for patients undergoing surgery that are prepared by pharmacy in advance |
Anaesthesiologists | Environmental context and resources | ||
Caruso et al. (2017) [45] USA | Quasi-experimental (pre-post) | Social influences | Multidisciplinary collaboration: - Teamwork between specialties to develop plans in order to increase SAP adherence |
Paediatric anaesthesiologists Surgeons Infectious disease physicians Pharmacists Quality improvement specialists | Behavioural regulation | Audit and feedback: - Monitoring of adherence via compliance reports Support tools: - Incorporating antibiotic order set into pre-existing pre-surgical admission routine work Guideline dissemination: - Dissemination of dosage information via signs posted in theatre and visual aid pocket cards | |
Environmental context and resources | |||
Knowledge | |||
Collier et al. (1998) [46] USA | Quasi-experimental (pre-post) | Knowledge | Educational services: - Workshops to inform clinical staff of organisational changes that would be made to improve practice |
Vascular surgeons Anaesthetists Theatre and ward nurses Pharmacists | Environmental context and resources | Other enablers: - Rectifying issues as they are identified | |
Conaty et al. (2018) [47] Ireland | Quasi-experimental (pre-post) | Behavioural regulation | Audit and feedback: - Weekly audit and feedback sessions (regular surveillance) |
Orthopaedic surgeons Anaesthetists Nurses Pharmacists | Knowledge | Educational services: - Educational workshops and reminders on appropriate SAP Guideline dissemination: - Dissemination of guidelines electronically and through posters displayed in theatre | |
Environmental context and resources | |||
De Almeida et al. (2012) [48] Brazil | Quasi-experimental (pre-post) | Social influences | Multidisciplinary collaboration: - Collaboration between an ICU pharmacist and infectious diseases physician when reviewing patients to ensure guidelines are adhered to |
Infectious disease physician Pharmacist Intensivist | Environmental context and resources | Audit and feedback: - Continual surveillance through compliance reports disseminated electronically and verbally | |
Dimopoulou et al. (2016) [49] Greece | Quasi-experimental (pre-post) | Knowledge | Educational services: - Workshops regarding appropriate SAP and SSI prevention Guideline dissemination: - Distribution of guidelines to clinical team |
Paediatric surgeons, nurses and anaesthetists | Environmental context and resources | ||
Social/professional role and identity | Role delegation: - Transferring the responsibility of SAP prescribing to the surgeon, whilst administration of antibiotics is to be carried out by the ward nurse or anaesthetist | ||
Reinforcement | Local opinion leader: - Use of a champion or a leader to assist with adhering to guidelines (to reinforce guideline use) | ||
Social influences | |||
Garcell et al. (2017) [50] Qatar | Quasi-experimental (pre-post) | Behavioural regulation | Audit and feedback: - Regular audit and feedback sessions |
Surgical staff | Knowledge | Educational services: - Discussions around local SAP policy | |
Environmental context and resources | |||
Haynes et al. (2011) [51] USA | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - Use of a special antibiotic order set with an automated time system to force cessation of antibiotic use once time was exceeded. Removing the prescribing duration from the prescriber |
Physicians | Environmental context and resources | ||
Hermsen et al. (2008) [52] USA | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - Development and use of a standardised antibiotic order form to provide guidance on antibiotic choice, duration and dose Educational services: - Educational sessions to doctors, pharmacists and nurses in regards to the form and the Surgical Infection Prevention Program |
Physicians Pharmacists Nurses | Environmental context and resources | ||
Knowledge | |||
Hincker et al. (2017) [53] USA | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - Modification of EMR system to include decision support tool to guide antibiotic choice and re-dosing interval Real-time reminders: - Electronic reminder (on EMR) to indicate when patient should be re-dosed; real-time information |
Anaesthesia staff | Environmental context and resources | ||
Reinforcement | |||
Kao et al. (2010) [54] USA | Staggered cohort | Knowledge | Educational sessions: - Lectures to clinical staff - Drawing attention to importance of compliance Support tools: - Use of a preoperative checklist and standardised forms to order antibiotics Other enablers: - Staggering introduction of interventions to give staff an opportunity to implement change |
Anaesthesia and surgical staff | Environmental context and resources | ||
Behavioural regulation | |||
Kim et al. (2012) [55] Korea | Quasi-experimental (pre-post) | Behavioural regulation | Audit and feedback: - Reporting of results to the public as well as to hospitals |
Not specified | |||
Kritchevsky et al. (2008) [56] USA | Cluster randomised trial | Behavioural regulation | Support tools: -Development of prewritten order set for antibiotics -Guidelines, forms and literature reviews shared amongst intervention hospitals -Monthly conferences Audit and feedback: -Comparative feedback reports sent to all participating hospitals Educational services: - Monthly conferences held to discuss issues and successes experienced by participating intervention hospitals -Meetings held to discuss strategies on how to overcome obstacles related to practice |
Physician assistants Nurse practitioners Pharmacists Surgeons Anaesthesiologists | Environmental context and resources | ||
Knowledge | |||
Lingard et al. (2011) [57] Canada | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - Use of a checklist to prompt antibiotic use and documentation Effective communication: - Comprehensive preoperative team briefings: enhanced communication between multidisciplinary staff members |
General surgeons Anaesthesiologists Theatre nurses Technical assistants | Environmental context and resources | ||
Skills | |||
Nair et al. (2010) [58] USA | Quasi-experimental (pre-post) | Environmental context and resources | Support tools: - Implementation of AIMS: electronic anaesthesia documentation system Audit and feedback: - Regular performance reports indicating success rates - Electronic reminders (via email) to document antibiotic information if missing in AIMS Real-time reminders: - Real-time electronic feedback and reminders via a decision support system known as SAMs which is linked to AIMS; reminders to carry out specific action |
Anaesthesiologists Nurse anaesthetists | Behavioural regulation | ||
Reinforcement | |||
Nair et al. (2011) [59] USA | Quasi-experimental (pre-post) | Environmental context and resources | Real-time reminders: - Use of SAMs: real time alerts to prompt antibiotic administration in a timely fashion. Frequent messages until action taken |
Anaesthesia staff | Behavioural regulation | ||
Reinforcement | |||
O’Reilly et al. (2006) [60] USA | Quasi-experimental (pre-post) | Environmental context and resources | Support tools: - Modification of electronic perioperative systems to allow documentation of antibiotic particulars Audit and feedback: - Regular performance feedback to individual staff members (electronic). Verbal feedback given to staff who are constantly non-compliant - Publication of performance results to serve as a reminder as well as verbal reminders during staff meetings |
Surgeons Nurses Anaesthesia staff | Behavioural regulation | ||
Social/professional role and identity | Role delegation: - Anaesthetists responsible for administering antibiotics | ||
Ozgun et al. (2010) [61] Turkey | Quasi-experimental (pre-post) | Knowledge | Educational services: - Educational sessions held regarding SAP principles as well as what is considered inappropriate use - Data on current practice presented to staff - Discussion of specialty specific issues discussed with surgical team Guideline dissemination: - SAP guidelines distributed during staff meetings and displayed throughout hospital |
Surgeons Anaesthetists Nurses | Environmental | ||
context and resources | |||
Parker et al. (2007) [62] USA | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: -Use of standardised preoperative antibiotic order forms Real time reminders: -Use of an anaesthesia record keeping system to remind anaesthesia provider of appropriate time to administer antibiotics |
Non-cardiac surgeons Anaesthesiologists and anaesthesia care providers Preoperative nursing staff | Environmental context and resources | ||
Reinforcement | |||
Social/professional role and identity | Role delegation: -Delegating role of confirming and administering antibiotic prophylaxis to anaesthesia personnel -Antibiotics sent with patients to theatre in order to assist with its administration before incision | ||
Knowledge | Educational sessions: -Educating staff on antibiotic prophylaxis in order to change attitudes towards use | ||
Environmental context and resources | |||
Ribed et al. (2018) [63] Spain | Quasi-experimental (pre-post) | Environmental context and resources | Support tools: - Prepopulating SAP information onto the CPOE to assist with correct antibiotic prescribing Real-time reminders: - Integrating reminders into clinician’s workflow to modify patient’s prescription based on lab results Educational services: - Educational sessions to increase SAP awareness - Pharmacy led training sessions on how to use the CPOE |
Orthopaedic surgeons Nurses Pharmacists | Behavioural regulation | ||
Reinforcement | |||
Knowledge | |||
Riggi et al. (2014) [64] USA | Quasi-experimental (pre-post) | Environmental context and resources | Real-time reminders: - Use of an automated intraoperative paging system to ensure antibiotics are re-dosed at the appropriate time during lengthy procedures Educational services: - Education sessions to anaesthesiology and surgical staff Audit and feedback: - Feedback to staff when non-compliance occurred (to individual staff member and chairman of anaesthesiology) Other enablers: - Standardisation of SAP protocol (hospital wide) |
Surgical staff Anaesthesia staff | Knowledge | ||
Behavioural regulation | |||
Reinforcement | |||
Ritchie et al. (2004) [65] New Zealand | Quasi-experimental (pre-post) | Behavioural regulation | Real-time reminders: - Use of a pre-printed sticker on medication chart that included antibiotic particulars (dose, duration and dosing interval) to assist with correct prescribing: information present at point of care – immediate reminder of antibiotic policy |
Anaesthetists Pharmacists | |||
Reinforcement | |||
Environmental context and resources | |||
Social/professional role and identity | Role delegation: - Anaesthetists responsible for applying sticker as they administer first dose | ||
Rosenberg et al. (2008) [66] USA | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - “Piggybacking” antibiotic administration verification to surgical time out sheet (preoperative checklist). Acts as a prompt to ensure antibiotics are administered prior to incision |
Anaesthesiologists Theatre nurses | Environmental context and resources | ||
Schwann et al. (2011) [67] USA | Quasi-experimental (pre-post) | Behavioural regulation | Real-time reminders: - Use of a POCEP to provide real-time notifications during a procedure to administer antibiotics: reminder system |
Anaesthesiologists Certified registered nurse anaesthetists Surgeons | Reinforcement | ||
Environmental context and resources | |||
Social/professional role and identity | Role delegation: - Anaesthesiologist or certified registered nurse anaesthetist responsible for validating the POCEP | ||
Shapiro et al. (2018) [68] USA | Quasi-experimental (pre-post) | Environmental context and resources | Educational services: - Educational sessions highlighting current recommendations: presentation of current practice highlighting antibiotic usage (transparency of practice) |
Gynaecological surgeons | Knowledge | ||
Sutherland et al. (2014) [69] USA | Quasi-experimental (pre-post) | Behavioural regulation | Audit and feedback and multidisciplinary collaboration: - Multidisciplinary involvement in feedback committee - Discussions/contact made with staff who are constantly non-compliant to review practice |
Anaesthesiologists Surgeons | Social influences | ||
Telfah et al. (2015) [70] Jordan | Quasi-experimental (pre-post) | Knowledge | Educational services: -Revising guidelines to ensure it is comprehensive then providing education to clinical staff to increase awareness -One to one educational sessions and email reminders also provided |
Medical, nursing and pharmacy staff Surgical residents | Environmental context and resources | ||
Social/professional role and identity | Role delegation: - Assigning a clinical pharmacist to review and evaluate prescribed medications to ensure compliance | ||
Environmental context and resources | Other enablers: -Creation of a theatre satellite pharmacy to allow pharmacists to review and process all orders prior to supply, whilst also restricting access to antibiotics | ||
Wax et al. (2007) [71] USA | Quasi-experimental (pre-post) | Reinforcement | Real-time reminders: -Activation of a visual reminder on the AIMS to ensure antibiotics are given before incision |
Anaesthesia care team (certified registered nurse anaesthetist, anaesthesia house staff and attending anaesthesiologist) | Behavioural regulation | ||
Environmental context and resources | |||
Whitman et al. (2008) [72] USA | Quasi-experimental (pre-post) | Social/professional role and identity | Role delegation: - Anaesthetists assumed responsibility of antibiotic administration in theatre |
Anaesthetists | Behavioural regulation | Support tools: - Use of a preoperative order form in preadmission clinic to ensure antibiotics are charted early Other enablers: - Ensuring patients don’t leave hold area until antibiotics are administered | |
Environmental context and resources | |||
Willems et al. (2005) [73] Belgium | Quasi-experimental (pre-post) | Behavioural regulation | Audit and feedback: - Highlighting cost to hospital when SAP not adhered to (use of a follow up form to highlight cost of antibiotics when following SAP guidelines vs the antibiotic regimen used by the doctor) |
Physicians | |||
Zanetti et al. (2003) [74] USA | Randomised control trial | Environmental context and resources | Real-time reminders: - Use of an audible alarm (computer generated) to notify staff when antibiotic needs to be re-dosed as well as pop-up notification displaying re-dosing guidelines |
Surgical staff | Behavioural regulation | ||
Reinforcement | |||
Zanotto et al. (2006) [75] Brazil | Quasi-experimental (pre-post) | Behavioural regulation | Support tools: - Placing software restrictions on certain antibiotics to limit inappropriate prescribing - Interruption of dispensing if no reason documented electronically to justify extended antibiotic use |
Not specified | Environmental context and resources | ||
Zhou et al. (2016) [76] China | Quasi-experimental (pre-post) | Social/professional role and identity | Role delegation: - Delegating task of reviewing antimicrobial prescribing to clinical pharmacist |
Pharmacists Surgeons Nurses | Knowledge | Educational services: - Educational sessions to medical, surgical and nursing staff regarding appropriate SAP | |
Environmental context | |||
Behavioural regulation | Audit and feedback: - Weekly performance reports regarding SAP adherence and irrational antibiotic use - Communication between staff when inappropriate prescribing detected |