Research Articles from the SHS-UHN ASP (Category)

Implementing Antimicrobial Stewardship-Oriented Guidelines Using a Change Management Approach: The Example of Febrile Neutropenia

M So
S Husain
Y Nakamachi
J Costello
AC Schuh
M Steinberg
CM Bell
AM Morris



Background:  To reduce unnecessary antimicrobial use in oncology-hematology patients, we developed and implemented a set of facility-specific, antimicrobial stewardship-oriented febrile neutropenia guidelines for leukemia and stem cell transplant patients using a healthcare change management framework.

Methods:   The patient setting was a tertiary cancer center in Toronto, Canada.  The framework has six core elements:  1) governance and leadership; 2) stakeholder engagement; 3) workflow analysis and integration; 4) communications; 5) training and education; and 6) monitoring and evaluation.  We applied elements 1-3 to guidelines design, and 4-6 to guidelines dissemination and implementation.

Results.  Element 1) the guidelines were developed by the Antimicrobial Stewardship Program (ASP) and sponsored by the Malignant Hematology Program’s senior leadership.  They determined the guidelines’ scope.  Element 2) two ASP team members drafted the guidelines after a literature review.  Clinical leaders, content experts, and clinician end-users reviewed the draft.  Their feedback was incorporated in the guidelines.  Element 3) healthcare human factors engineers conducted a qualitative study with clinicians to optimize guidelines usability, creating a format that is interactive and embedded with hyperlinks for efficient user-interface at point-of-care.  Element 4) we informed clinicians that the finalized guidelines are available on our website.  Element 5) we demonstrated the guidelines to clinicians at audience-specific venues. Element 6) we continuously report antimicrobial consumption, expenditure, guidelines adherence, and indications of antimicrobials to stakeholders and clinicians.

Conclusion.  A healthcare change management framework facilitated the successful development and implementation of new febrile neutropenia guidelines that promote antimicrobial stewardship and standardization of care in malignant hematology patients.


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