Introduction

Antimicrobial stewardship (AMS) programs in hospitals serve as a critical link between effective infection management, healthcare quality, and patient safety. As the overuse and misuse of antimicrobials increase resistance, implementing effective strategies to optimise antimicrobial use has become imperative.1 Hospital AMS programs aim to promote the responsible and judicious use of antimicrobial agents, ensuring that patients receive the right medication at the right dose and duration. These programs use a multidisciplinary team of specialised doctors and pharmacists to implement guidelines, education and training initiatives, post-prescription audit and feedback, and point-of-care interventions.2
Antimicrobial prescribing in hospitals is unique in that while prescribers have autonomy over their patient’s treatment, AMS teams provide oversight. One significant challenge is the need to overcome ingrained prescribing practices, such as decision-making based on clinical intuition rather than evidence-based guidelines.3,4 Additionally, striking a balance between optimising antimicrobial use and ensuring timely treatment for critically ill patients can be challenging. Delayed initiation of appropriate therapy can pose risks for patients with severe infections.5,6 AMS programs must navigate these challenges, integrating education, feedback, and collaboration to achieve optimal outcomes while minimising potential negative impacts.
The digitisation of hospitals, including the implementation of electronic health records and electronic medication management systems (eMMS), has the potential to optimise AMS programs.7Digital platforms can integrate clinical decision support systems that offer evidence-based guidelines and recommendations at the point of care, helping clinicians select the most appropriate antimicrobial agent, dose, and duration. However, implementation of digital interventions is complex. While digital interventions have the potential to enhance AMS, they are not automatically accepted and used by clinicians.8 A systematic review of health technology implementation in hospitals found that even when different hospitals adopt the same systems, contextual factors influence utilisation.9 Therefore, understanding the contextual factors influencing AMS work can provide insight into how technology is utilised and how AMS programs can be optimised. The objective of this study was to examine and understand the work processes of AMS teams across two hospitals that use the same digital intervention, and to identify the challenges and enablers to effective AMS in each setting. We hoped that identifying factors that impact use of technology, and effective AMS more broadly, would be of value to other organisations implementing or evaluating their AMS programs.