BACKGROUND Antibiotics play a crucial role in preventing surgical site infections, yet adherence to Infectious Disease Society of America (IDSA) guidelines varies widely. This qualitative study aimed to explore factors influencing perioperative antibiotic administration and assess the potential impact of a clinical decision support (CDS) tool on guideline adherence. METHODS In this qualitative study, perioperative personnel with diverse roles (surgeons, anesthesiologists, certified nurse anesthetists, trainees, and pharmacists) were interviewed using a semi-structured interview format from September 2023 through April 2024. Interviews were then analyzed for codes which were assigned to concepts using the constant comparison method for assessment of factors that were described as barriers or facilitators of guideline adherence. RESULTS After piloting with three interviews, we conducted nine sessions with a total of 17 participants: 7 attending anesthesiologists, 3 resident trainees, 2 perioperative pharmacists, 3 Certified Registered Nurse Anesthetists (CRNAs), and 2 attending surgeons. Key themes emerged: (1) Limited familiarity with Infectious Disease Society of America (IDSA) antibiotic guidelines, (2) Lack of standardization and optimization of antibiotic decision-making process, (3) Challenges with managing beta-lactam allergies, (4) Difficulty optimizing vancomycin timing, and (5) Perceived benefit of a Clinical Decision Support (CDS) tool in enhancing workflow and guideline adherence. CONCLUSIONS Non-adherence to antibiotic guidelines in the perioperative setting often results from a lack of structured workflow. Our interviews provide a foundation for developing a clinical decision support tool tailored to provider needs, aiming to improve user satisfaction and promote better adherence to perioperative antibiotic guidelines.

中文翻译：

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在三级医疗保健系统中有助于指南非依从性手术抗生素预防的个体和系统水平因素：定性分析。


背景 抗生素在预防手术部位感染方面起着至关重要的作用，但对美国传染病学会 （IDSA） 指南的依从性差异很大。这项定性研究旨在探讨影响围手术期抗生素给药的因素，并评估临床决策支持 （CDS） 工具对指南依从性的潜在影响。方法 在这项定性研究中，从 2023 年 9 月到 2024 年 4 月，使用半结构化访谈形式对具有不同角色的围手术期人员（外科医生、麻醉师、认证护士麻醉师、实习生和药剂师）进行了访谈。然后，使用常数比较法分析访谈中分配给概念的代码，以评估被描述为指南遵守的障碍或促进因素的因素。结果在进行 3 次访谈试点后，我们进行了 9 次会议，共有 17 名参与者：7 名主治麻醉师、3 名住院医师、2 名围手术期药剂师、3 名认证注册护士麻醉师 （CRNA） 和 2 名主治外科医生。出现了关键主题：（1） 对美国传染病学会 （IDSA） 抗生素指南的熟悉程度有限，（2） 缺乏抗生素决策过程的标准化和优化，（3） 管理 β-内酰胺类过敏的挑战，（4） 难以优化万古霉素的时间，以及 （5） 临床决策支持 （CDS） 工具在增强工作流程和指南依从性方面的感知益处。结论 围手术期不遵守抗生素指南通常是由于缺乏结构化工作流程造成的。 我们的访谈为开发针对提供者需求量身定制的临床决策支持工具奠定了基础，旨在提高用户满意度并促进更好地遵守围手术期抗生素指南。