An exploration of workarounds and their perceived impact on antibiotic stewardship in the adult medical wards of a referral hospital ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Chimwemwe Tusekile Mula, Nicola Human, Lyn Middleton

ABSTRACT

BACKGROUND: Antibiotic stewardship, the proper management of antibiotics to ensure optimal patient outcomes, is based on quality improvement. Evidence-based guidelines and protocols have been developed to improve this process of care. Safe and timely patient care also requires optimal coordination of staff, resources, equipment, schedules and tasks. However, healthcare workers encounter barriers when implementing these standards and engage in workarounds to overcome these barriers. Workarounds bypass or temporarily 'fix' perceived workflow hindrances to achieve a goal more readily. This study examines workaround behaviours that nurses and doctors employ to address the challenges encountered during their antibiotic stewardship efforts and their impact, at a tertiary hospital in Malawi. METHODS: This was a qualitative descriptive case study design and is part of a large mixed methods study aimed at understanding nurses' role in antibiotic stewardship and identifying barriers that informed the development of nurse-focused interventions. For this study, we conducted interviews with staff and observations of nurses antibiotic stewardship practices on two adult medical wards. We convened three focus group discussions with doctors, pharmacists and laboratory technologists (n = 20), focusing on their attitudes and experiences with nurses' roles in antibiotic stewardship. We also observed nurses' antibiotic stewardship practices and interactions duringfour events: shift change handovers (n = 10); antibiotic preparation (n = 13); antibiotic administration (n = 49 cases); and ward rounds (n = 7). After that, the researcher conducted follow up interviews with purposively selected observed nurses (n = 13). RESULTS: Using inductive and deductive approaches to thematic analysis, we found that nurses established their ways of overcoming challenges to achieve the intended task goals with workarounds. We also found that nurses' practices influenced doctors' workarounds. We identified six themes related to workarounds and grouped them into two categories: "Taking shortcuts by altering a procedure" and "Using unauthorized processes". These behaviors may have both positive and negative impacts on patient care and the health care system. CONCLUSION: The study provided insight into how nurses and doctors work around workflow blocks encountered during patient antibiotic management at a tertiary hospital in Malawi. We identified two categories of workaround namely taking shortcuts by altering a procedure and using unauthorized processes. Addressing the blocks in the system by providing adequate resources, training, improving multidisciplinary teamwork and supportive supervision can minimize workarounds. More... »

PAGES

64

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12913-019-3900-0

DOI

http://dx.doi.org/10.1186/s12913-019-3900-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111616040

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30674316


Indexing Status Check whether this publication has been indexed by Scopus and Web Of Science using the SN Indexing Status Tool
Incoming Citations Browse incoming citations for this publication using opencitations.net

JSON-LD is the canonical representation for SciGraph data.

TIP: You can open this SciGraph record using an external JSON-LD service: JSON-LD Playground Google SDTT

[
  {
    "@context": "https://springernature.github.io/scigraph/jsonld/sgcontext.json", 
    "about": [
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/1117", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Public Health and Health Services", 
        "type": "DefinedTerm"
      }, 
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/11", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Medical and Health Sciences", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Adult", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Antimicrobial Stewardship", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Attitude of Health Personnel", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Case-Control Studies", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Female", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Health Personnel", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Humans", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Malawi", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Male", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Nurse's Role", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Nursing Staff, Hospital", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Perception", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Physician's Role", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Physicians", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Professional Practice", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Qualitative Research", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Referral and Consultation", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Tertiary Care Centers", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Workflow", 
        "type": "DefinedTerm"
      }
    ], 
    "author": [
      {
        "affiliation": {
          "alternateName": "University of KwaZulu-Natal", 
          "id": "https://www.grid.ac/institutes/grid.16463.36", 
          "name": [
            "Department of Clinical Nursing, University of Malawi, Kamuzu College of Nursing, Blantyre, Malawi", 
            "School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Mula", 
        "givenName": "Chimwemwe Tusekile", 
        "id": "sg:person.014615554347.15", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.014615554347.15"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "University of KwaZulu-Natal", 
          "id": "https://www.grid.ac/institutes/grid.16463.36", 
          "name": [
            "School of Health Sciences, Department of Pharmacy, University of KwaZulu-Natal, Durban, South Africa"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Human", 
        "givenName": "Nicola", 
        "id": "sg:person.011675765547.19", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.011675765547.19"
        ], 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "University of KwaZulu-Natal", 
          "id": "https://www.grid.ac/institutes/grid.16463.36", 
          "name": [
            "School of Health Sciences, Department of Pharmacy, University of KwaZulu-Natal, Durban, South Africa"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Middleton", 
        "givenName": "Lyn", 
        "id": "sg:person.01247766337.78", 
        "sameAs": [
          "https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01247766337.78"
        ], 
        "type": "Person"
      }
    ], 
    "citation": [
      {
        "id": "https://doi.org/10.1197/jamia.m2378", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1000629928"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1016/j.ijhcs.2011.08.002", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1002730170"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1197/jamia.m2616", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1003325240"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1093/jac/dkr370", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1007219109"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "sg:pub.10.1186/1472-6963-13-175", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1008205533", 
          "https://doi.org/10.1186/1472-6963-13-175"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.7812/tpp/13-141", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1011009825"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.3389/fmicb.2016.01860", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1011706199"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1097/hmr.0b013e3181d116c2", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1015729688"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1097/hmr.0b013e3181d116c2", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1015729688"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.4065/mcp.2011.0358", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1018905384"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1145/1056808.1056966", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1019484768"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "sg:pub.10.1007/978-0-387-89370-9_4", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1031358084", 
          "https://doi.org/10.1007/978-0-387-89370-9_4"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1097/nna.0b013e31827860ff", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1038230881"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1097/nna.0b013e31827860ff", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1038230881"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1111/j.1475-6773.2006.00502.x", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1043200776"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1111/j.1475-6773.2006.00502.x", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1043200776"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1097/01.hmr.0000304495.95522.ca", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1043606064"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1097/01.hmr.0000304495.95522.ca", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1043606064"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.3122/jabfm.2015.s1.150133", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1045504318"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1086/510393", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1047721791"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1136/amiajnl-2013-001686", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1050205465"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1093/cid/cix065", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1083842163"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.17705/1thci.00070", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1092884751"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.17705/1cais.03455", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1109867308"
        ], 
        "type": "CreativeWork"
      }
    ], 
    "datePublished": "2019-12", 
    "datePublishedReg": "2019-12-01", 
    "description": "BACKGROUND: Antibiotic stewardship, the proper management of antibiotics to ensure optimal patient outcomes, is based on quality improvement. Evidence-based guidelines and protocols have been developed to improve this process of care. Safe and timely patient care also requires optimal coordination of staff, resources, equipment, schedules and tasks. However, healthcare workers encounter barriers when implementing these standards and engage in workarounds to overcome these barriers. Workarounds bypass or temporarily 'fix' perceived workflow hindrances to achieve a goal more readily. This study examines workaround behaviours that nurses and doctors employ to address the challenges encountered during their antibiotic stewardship efforts and their impact, at a tertiary hospital in Malawi.\nMETHODS: This was a qualitative descriptive case study design and is part of a large mixed methods study aimed at understanding nurses' role in antibiotic stewardship and identifying barriers that informed the development of nurse-focused interventions. For this study, we conducted interviews with staff and observations of nurses antibiotic stewardship practices on two adult medical wards. We convened three focus group discussions with doctors, pharmacists and laboratory technologists (n\u2009=\u200920), focusing on their attitudes and experiences with nurses' roles in antibiotic stewardship. We also observed nurses' antibiotic stewardship practices and interactions duringfour events: shift change handovers (n\u2009=\u200910); antibiotic preparation (n\u2009=\u200913); antibiotic administration (n\u2009=\u200949 cases); and ward rounds (n\u2009=\u20097). After that, the researcher conducted follow up interviews with purposively selected observed nurses (n\u2009=\u200913).\nRESULTS: Using inductive and deductive approaches to thematic analysis, we found that nurses established their ways of overcoming challenges to achieve the intended task goals with workarounds. We also found that nurses' practices influenced doctors' workarounds. We identified six themes related to workarounds and grouped them into two categories: \"Taking shortcuts by altering a procedure\" and \"Using unauthorized processes\". These behaviors may have both positive and negative impacts on patient care and the health care system.\nCONCLUSION: The study provided insight into how nurses and doctors work around workflow blocks encountered during patient antibiotic management at a tertiary hospital in Malawi. We identified two categories of workaround namely taking shortcuts by altering a procedure and using unauthorized processes. Addressing the blocks in the system by providing adequate resources, training, improving multidisciplinary teamwork and supportive supervision can minimize workarounds.", 
    "genre": "research_article", 
    "id": "sg:pub.10.1186/s12913-019-3900-0", 
    "inLanguage": [
      "en"
    ], 
    "isAccessibleForFree": true, 
    "isPartOf": [
      {
        "id": "sg:journal.1327417", 
        "issn": [
          "1472-6963"
        ], 
        "name": "BMC Health Services Research", 
        "type": "Periodical"
      }, 
      {
        "issueNumber": "1", 
        "type": "PublicationIssue"
      }, 
      {
        "type": "PublicationVolume", 
        "volumeNumber": "19"
      }
    ], 
    "name": "An exploration of workarounds and their perceived impact on antibiotic stewardship in the adult medical wards of a referral hospital in Malawi: a qualitative study", 
    "pagination": "64", 
    "productId": [
      {
        "name": "readcube_id", 
        "type": "PropertyValue", 
        "value": [
          "26f25a519f36d8961717ff0974b42689cab2d76f3123cfd99d605f315fdd41c6"
        ]
      }, 
      {
        "name": "pubmed_id", 
        "type": "PropertyValue", 
        "value": [
          "30674316"
        ]
      }, 
      {
        "name": "nlm_unique_id", 
        "type": "PropertyValue", 
        "value": [
          "101088677"
        ]
      }, 
      {
        "name": "doi", 
        "type": "PropertyValue", 
        "value": [
          "10.1186/s12913-019-3900-0"
        ]
      }, 
      {
        "name": "dimensions_id", 
        "type": "PropertyValue", 
        "value": [
          "pub.1111616040"
        ]
      }
    ], 
    "sameAs": [
      "https://doi.org/10.1186/s12913-019-3900-0", 
      "https://app.dimensions.ai/details/publication/pub.1111616040"
    ], 
    "sdDataset": "articles", 
    "sdDatePublished": "2019-04-11T12:16", 
    "sdLicense": "https://scigraph.springernature.com/explorer/license/", 
    "sdPublisher": {
      "name": "Springer Nature - SN SciGraph project", 
      "type": "Organization"
    }, 
    "sdSource": "s3://com-uberresearch-data-dimensions-target-20181106-alternative/cleanup/v134/2549eaecd7973599484d7c17b260dba0a4ecb94b/merge/v9/a6c9fde33151104705d4d7ff012ea9563521a3ce/jats-lookup/v90/0000000361_0000000361/records_54017_00000001.jsonl", 
    "type": "ScholarlyArticle", 
    "url": "https://link.springer.com/10.1186%2Fs12913-019-3900-0"
  }
]
 

Download the RDF metadata as:  json-ld nt turtle xml License info

HOW TO GET THIS DATA PROGRAMMATICALLY:

JSON-LD is a popular format for linked data which is fully compatible with JSON.

curl -H 'Accept: application/ld+json' 'https://scigraph.springernature.com/pub.10.1186/s12913-019-3900-0'

N-Triples is a line-based linked data format ideal for batch operations.

curl -H 'Accept: application/n-triples' 'https://scigraph.springernature.com/pub.10.1186/s12913-019-3900-0'

Turtle is a human-readable linked data format.

curl -H 'Accept: text/turtle' 'https://scigraph.springernature.com/pub.10.1186/s12913-019-3900-0'

RDF/XML is a standard XML format for linked data.

curl -H 'Accept: application/rdf+xml' 'https://scigraph.springernature.com/pub.10.1186/s12913-019-3900-0'


 

This table displays all metadata directly associated to this object as RDF triples.

222 TRIPLES      21 PREDICATES      68 URIs      40 LITERALS      28 BLANK NODES

Subject Predicate Object
1 sg:pub.10.1186/s12913-019-3900-0 schema:about N022916f928c84b89bc8850464d3d333d
2 N08e73ea2cc40496b825672515ced286c
3 N08fe76ead5ef4d00a18ec8d39917c19c
4 N12b962f20ccd48ea8e4b148ffc2f296f
5 N42b2c5230a0349819cb0adab31e6f730
6 N4f25da88db2f4ea39c81c6400964ed57
7 N6549fb935bf742ec807bdb369447d64e
8 N68a634caff924c4fa85d1056d14a45ed
9 N7a440311d9ad4c63b4c5fd172009fd3f
10 N7a9fb35454f345d0ba55c7b13803a72e
11 Nbd846a9c95ad457ab788cdf43ed5c287
12 Nc1e9e1eb73244c2484c168b86d9c71f5
13 Nd1b47671017b418fb24783a3d2a8ce3a
14 Nd31917c6ef49461ebe9ce559d7c81d2c
15 Nd6bd67dd48f143eda98e72476534dc64
16 Ne4c097c86d024c59963a976a76dbff19
17 Neda1e1b42ca94df8a54550387783d200
18 Nf26bad4dd3964fd69cd0077595423175
19 Nf9ac7b54a6bc4cf9ab21c6aa7ffc285e
20 anzsrc-for:11
21 anzsrc-for:1117
22 schema:author N0ac7a5e0c7be439ba3b53303e355ab7b
23 schema:citation sg:pub.10.1007/978-0-387-89370-9_4
24 sg:pub.10.1186/1472-6963-13-175
25 https://doi.org/10.1016/j.ijhcs.2011.08.002
26 https://doi.org/10.1086/510393
27 https://doi.org/10.1093/cid/cix065
28 https://doi.org/10.1093/jac/dkr370
29 https://doi.org/10.1097/01.hmr.0000304495.95522.ca
30 https://doi.org/10.1097/hmr.0b013e3181d116c2
31 https://doi.org/10.1097/nna.0b013e31827860ff
32 https://doi.org/10.1111/j.1475-6773.2006.00502.x
33 https://doi.org/10.1136/amiajnl-2013-001686
34 https://doi.org/10.1145/1056808.1056966
35 https://doi.org/10.1197/jamia.m2378
36 https://doi.org/10.1197/jamia.m2616
37 https://doi.org/10.17705/1cais.03455
38 https://doi.org/10.17705/1thci.00070
39 https://doi.org/10.3122/jabfm.2015.s1.150133
40 https://doi.org/10.3389/fmicb.2016.01860
41 https://doi.org/10.4065/mcp.2011.0358
42 https://doi.org/10.7812/tpp/13-141
43 schema:datePublished 2019-12
44 schema:datePublishedReg 2019-12-01
45 schema:description BACKGROUND: Antibiotic stewardship, the proper management of antibiotics to ensure optimal patient outcomes, is based on quality improvement. Evidence-based guidelines and protocols have been developed to improve this process of care. Safe and timely patient care also requires optimal coordination of staff, resources, equipment, schedules and tasks. However, healthcare workers encounter barriers when implementing these standards and engage in workarounds to overcome these barriers. Workarounds bypass or temporarily 'fix' perceived workflow hindrances to achieve a goal more readily. This study examines workaround behaviours that nurses and doctors employ to address the challenges encountered during their antibiotic stewardship efforts and their impact, at a tertiary hospital in Malawi. METHODS: This was a qualitative descriptive case study design and is part of a large mixed methods study aimed at understanding nurses' role in antibiotic stewardship and identifying barriers that informed the development of nurse-focused interventions. For this study, we conducted interviews with staff and observations of nurses antibiotic stewardship practices on two adult medical wards. We convened three focus group discussions with doctors, pharmacists and laboratory technologists (n = 20), focusing on their attitudes and experiences with nurses' roles in antibiotic stewardship. We also observed nurses' antibiotic stewardship practices and interactions duringfour events: shift change handovers (n = 10); antibiotic preparation (n = 13); antibiotic administration (n = 49 cases); and ward rounds (n = 7). After that, the researcher conducted follow up interviews with purposively selected observed nurses (n = 13). RESULTS: Using inductive and deductive approaches to thematic analysis, we found that nurses established their ways of overcoming challenges to achieve the intended task goals with workarounds. We also found that nurses' practices influenced doctors' workarounds. We identified six themes related to workarounds and grouped them into two categories: "Taking shortcuts by altering a procedure" and "Using unauthorized processes". These behaviors may have both positive and negative impacts on patient care and the health care system. CONCLUSION: The study provided insight into how nurses and doctors work around workflow blocks encountered during patient antibiotic management at a tertiary hospital in Malawi. We identified two categories of workaround namely taking shortcuts by altering a procedure and using unauthorized processes. Addressing the blocks in the system by providing adequate resources, training, improving multidisciplinary teamwork and supportive supervision can minimize workarounds.
46 schema:genre research_article
47 schema:inLanguage en
48 schema:isAccessibleForFree true
49 schema:isPartOf N870bd071ca774ba7b044732208a5d718
50 Nfa5e42fddd3a41eda2dbf74f6ee12ff3
51 sg:journal.1327417
52 schema:name An exploration of workarounds and their perceived impact on antibiotic stewardship in the adult medical wards of a referral hospital in Malawi: a qualitative study
53 schema:pagination 64
54 schema:productId N721b56edbc2448d0857be43f679b3c6a
55 N803c8a99526a4776892b11b0c98e2c4c
56 Nc7387cdbf5bb453da101ffa3d4f1be95
57 Nf1f19f1744674560bb6f29aa4aa9f951
58 Nf20920a3a2f64fdca42985ccd4f215b6
59 schema:sameAs https://app.dimensions.ai/details/publication/pub.1111616040
60 https://doi.org/10.1186/s12913-019-3900-0
61 schema:sdDatePublished 2019-04-11T12:16
62 schema:sdLicense https://scigraph.springernature.com/explorer/license/
63 schema:sdPublisher N39f9a6fbbe5641d5bf1fdd0b33a9d285
64 schema:url https://link.springer.com/10.1186%2Fs12913-019-3900-0
65 sgo:license sg:explorer/license/
66 sgo:sdDataset articles
67 rdf:type schema:ScholarlyArticle
68 N022916f928c84b89bc8850464d3d333d schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
69 schema:name Qualitative Research
70 rdf:type schema:DefinedTerm
71 N08e73ea2cc40496b825672515ced286c schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
72 schema:name Malawi
73 rdf:type schema:DefinedTerm
74 N08fe76ead5ef4d00a18ec8d39917c19c schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
75 schema:name Antimicrobial Stewardship
76 rdf:type schema:DefinedTerm
77 N0ac7a5e0c7be439ba3b53303e355ab7b rdf:first sg:person.014615554347.15
78 rdf:rest N8567e47de95f4de98e27e8f04c21dc87
79 N12b962f20ccd48ea8e4b148ffc2f296f schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
80 schema:name Health Personnel
81 rdf:type schema:DefinedTerm
82 N2641dfd44e7940fdade0b1c3ae5788ba rdf:first sg:person.01247766337.78
83 rdf:rest rdf:nil
84 N39f9a6fbbe5641d5bf1fdd0b33a9d285 schema:name Springer Nature - SN SciGraph project
85 rdf:type schema:Organization
86 N42b2c5230a0349819cb0adab31e6f730 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
87 schema:name Adult
88 rdf:type schema:DefinedTerm
89 N4f25da88db2f4ea39c81c6400964ed57 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
90 schema:name Tertiary Care Centers
91 rdf:type schema:DefinedTerm
92 N6549fb935bf742ec807bdb369447d64e schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
93 schema:name Nurse's Role
94 rdf:type schema:DefinedTerm
95 N68a634caff924c4fa85d1056d14a45ed schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
96 schema:name Physician's Role
97 rdf:type schema:DefinedTerm
98 N721b56edbc2448d0857be43f679b3c6a schema:name doi
99 schema:value 10.1186/s12913-019-3900-0
100 rdf:type schema:PropertyValue
101 N7a440311d9ad4c63b4c5fd172009fd3f schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
102 schema:name Case-Control Studies
103 rdf:type schema:DefinedTerm
104 N7a9fb35454f345d0ba55c7b13803a72e schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
105 schema:name Humans
106 rdf:type schema:DefinedTerm
107 N803c8a99526a4776892b11b0c98e2c4c schema:name pubmed_id
108 schema:value 30674316
109 rdf:type schema:PropertyValue
110 N8567e47de95f4de98e27e8f04c21dc87 rdf:first sg:person.011675765547.19
111 rdf:rest N2641dfd44e7940fdade0b1c3ae5788ba
112 N870bd071ca774ba7b044732208a5d718 schema:issueNumber 1
113 rdf:type schema:PublicationIssue
114 Nbd846a9c95ad457ab788cdf43ed5c287 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
115 schema:name Physicians
116 rdf:type schema:DefinedTerm
117 Nc1e9e1eb73244c2484c168b86d9c71f5 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
118 schema:name Female
119 rdf:type schema:DefinedTerm
120 Nc7387cdbf5bb453da101ffa3d4f1be95 schema:name dimensions_id
121 schema:value pub.1111616040
122 rdf:type schema:PropertyValue
123 Nd1b47671017b418fb24783a3d2a8ce3a schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
124 schema:name Referral and Consultation
125 rdf:type schema:DefinedTerm
126 Nd31917c6ef49461ebe9ce559d7c81d2c schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
127 schema:name Male
128 rdf:type schema:DefinedTerm
129 Nd6bd67dd48f143eda98e72476534dc64 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
130 schema:name Attitude of Health Personnel
131 rdf:type schema:DefinedTerm
132 Ne4c097c86d024c59963a976a76dbff19 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
133 schema:name Nursing Staff, Hospital
134 rdf:type schema:DefinedTerm
135 Neda1e1b42ca94df8a54550387783d200 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
136 schema:name Workflow
137 rdf:type schema:DefinedTerm
138 Nf1f19f1744674560bb6f29aa4aa9f951 schema:name readcube_id
139 schema:value 26f25a519f36d8961717ff0974b42689cab2d76f3123cfd99d605f315fdd41c6
140 rdf:type schema:PropertyValue
141 Nf20920a3a2f64fdca42985ccd4f215b6 schema:name nlm_unique_id
142 schema:value 101088677
143 rdf:type schema:PropertyValue
144 Nf26bad4dd3964fd69cd0077595423175 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
145 schema:name Professional Practice
146 rdf:type schema:DefinedTerm
147 Nf9ac7b54a6bc4cf9ab21c6aa7ffc285e schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
148 schema:name Perception
149 rdf:type schema:DefinedTerm
150 Nfa5e42fddd3a41eda2dbf74f6ee12ff3 schema:volumeNumber 19
151 rdf:type schema:PublicationVolume
152 anzsrc-for:11 schema:inDefinedTermSet anzsrc-for:
153 schema:name Medical and Health Sciences
154 rdf:type schema:DefinedTerm
155 anzsrc-for:1117 schema:inDefinedTermSet anzsrc-for:
156 schema:name Public Health and Health Services
157 rdf:type schema:DefinedTerm
158 sg:journal.1327417 schema:issn 1472-6963
159 schema:name BMC Health Services Research
160 rdf:type schema:Periodical
161 sg:person.011675765547.19 schema:affiliation https://www.grid.ac/institutes/grid.16463.36
162 schema:familyName Human
163 schema:givenName Nicola
164 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.011675765547.19
165 rdf:type schema:Person
166 sg:person.01247766337.78 schema:affiliation https://www.grid.ac/institutes/grid.16463.36
167 schema:familyName Middleton
168 schema:givenName Lyn
169 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.01247766337.78
170 rdf:type schema:Person
171 sg:person.014615554347.15 schema:affiliation https://www.grid.ac/institutes/grid.16463.36
172 schema:familyName Mula
173 schema:givenName Chimwemwe Tusekile
174 schema:sameAs https://app.dimensions.ai/discover/publication?and_facet_researcher=ur.014615554347.15
175 rdf:type schema:Person
176 sg:pub.10.1007/978-0-387-89370-9_4 schema:sameAs https://app.dimensions.ai/details/publication/pub.1031358084
177 https://doi.org/10.1007/978-0-387-89370-9_4
178 rdf:type schema:CreativeWork
179 sg:pub.10.1186/1472-6963-13-175 schema:sameAs https://app.dimensions.ai/details/publication/pub.1008205533
180 https://doi.org/10.1186/1472-6963-13-175
181 rdf:type schema:CreativeWork
182 https://doi.org/10.1016/j.ijhcs.2011.08.002 schema:sameAs https://app.dimensions.ai/details/publication/pub.1002730170
183 rdf:type schema:CreativeWork
184 https://doi.org/10.1086/510393 schema:sameAs https://app.dimensions.ai/details/publication/pub.1047721791
185 rdf:type schema:CreativeWork
186 https://doi.org/10.1093/cid/cix065 schema:sameAs https://app.dimensions.ai/details/publication/pub.1083842163
187 rdf:type schema:CreativeWork
188 https://doi.org/10.1093/jac/dkr370 schema:sameAs https://app.dimensions.ai/details/publication/pub.1007219109
189 rdf:type schema:CreativeWork
190 https://doi.org/10.1097/01.hmr.0000304495.95522.ca schema:sameAs https://app.dimensions.ai/details/publication/pub.1043606064
191 rdf:type schema:CreativeWork
192 https://doi.org/10.1097/hmr.0b013e3181d116c2 schema:sameAs https://app.dimensions.ai/details/publication/pub.1015729688
193 rdf:type schema:CreativeWork
194 https://doi.org/10.1097/nna.0b013e31827860ff schema:sameAs https://app.dimensions.ai/details/publication/pub.1038230881
195 rdf:type schema:CreativeWork
196 https://doi.org/10.1111/j.1475-6773.2006.00502.x schema:sameAs https://app.dimensions.ai/details/publication/pub.1043200776
197 rdf:type schema:CreativeWork
198 https://doi.org/10.1136/amiajnl-2013-001686 schema:sameAs https://app.dimensions.ai/details/publication/pub.1050205465
199 rdf:type schema:CreativeWork
200 https://doi.org/10.1145/1056808.1056966 schema:sameAs https://app.dimensions.ai/details/publication/pub.1019484768
201 rdf:type schema:CreativeWork
202 https://doi.org/10.1197/jamia.m2378 schema:sameAs https://app.dimensions.ai/details/publication/pub.1000629928
203 rdf:type schema:CreativeWork
204 https://doi.org/10.1197/jamia.m2616 schema:sameAs https://app.dimensions.ai/details/publication/pub.1003325240
205 rdf:type schema:CreativeWork
206 https://doi.org/10.17705/1cais.03455 schema:sameAs https://app.dimensions.ai/details/publication/pub.1109867308
207 rdf:type schema:CreativeWork
208 https://doi.org/10.17705/1thci.00070 schema:sameAs https://app.dimensions.ai/details/publication/pub.1092884751
209 rdf:type schema:CreativeWork
210 https://doi.org/10.3122/jabfm.2015.s1.150133 schema:sameAs https://app.dimensions.ai/details/publication/pub.1045504318
211 rdf:type schema:CreativeWork
212 https://doi.org/10.3389/fmicb.2016.01860 schema:sameAs https://app.dimensions.ai/details/publication/pub.1011706199
213 rdf:type schema:CreativeWork
214 https://doi.org/10.4065/mcp.2011.0358 schema:sameAs https://app.dimensions.ai/details/publication/pub.1018905384
215 rdf:type schema:CreativeWork
216 https://doi.org/10.7812/tpp/13-141 schema:sameAs https://app.dimensions.ai/details/publication/pub.1011009825
217 rdf:type schema:CreativeWork
218 https://www.grid.ac/institutes/grid.16463.36 schema:alternateName University of KwaZulu-Natal
219 schema:name Department of Clinical Nursing, University of Malawi, Kamuzu College of Nursing, Blantyre, Malawi
220 School of Health Sciences, Department of Pharmacy, University of KwaZulu-Natal, Durban, South Africa
221 School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
222 rdf:type schema:Organization
 




Preview window. Press ESC to close (or click here)


...