Exploring prescribing practices and barriers to surgical antimicrobial prophylaxis compliance in a regional Australian hospital

Abstract Background Surgical antimicrobial prophylaxis (SAP) guidelines specify the most appropriate prescribing of antimicrobials. Despite evidence justifying the value of SAP guidelines, clinical practice continues to differ. Aim To determine SAP guideline compliance at a regional Australian hospital and identify any barriers influencing guideline adherence in this setting. Method This was a mixed method study. Part 1 was conducted in March 2023 and consisted of a retrospective audit of all surgeries at a regional, secondary hospital, located in New South Wales, Australia. De‐identified data collected included patient demographics, operation details, and perioperative antimicrobial dosing. Appropriateness of prescribing was assessed using definitions from the Surgical National Antimicrobial Prescribing Survey and Therapeutic Guidelines . Part 2 was a validated survey of all prescribers at the study site during March 2023 about perceived barriers and enablers to SAP guideline adherence, which were measured on 5‐point Likert Scales. Ethical approval was granted by the Greater Western Human Research Ethics Committee Low and Negligible Risk Research Review Committee (Reference no: 2023/ETH01971; Site authorisation no: 2023/STE03143) and the study conforms with the Australian National statement on ethical conduct in human research . Informed consent was obtained from all participants via distribution of project information and the completion of electronic consent forms. Results Overall, 352 surgical cases were reviewed, 248 antimicrobial prescriptions were included, and 34.5% of these were inappropriate. Eight causes of inappropriate prescribing were identified, with ‘antimicrobial prescribed when not indicated’ being the most common cause. Twenty‐seven prescribers responded to the survey, a response rate of 40.9%. Work demands and lack of training were reported as barriers, while Point of Care guidelines and greater education were identified as compliance enablers. Conclusion Compliance to SAP guidelines was low and prescribing was often inappropriate. A range of causes and factors for poor prescribing and suboptimal guideline adherence in a regional Australian context were identified. Understanding these factors is important to drive the development and delivery of targeted interventions, specific to regional settings, to improve guideline adherence.