Improving antibiotic use in daily hospital practice: The antibiotic checklist

Better use of current antibiotic agents is necessary to help control antimicrobial resistance (AMR). Antibiotic stewardship programs (ASPs) are introduced to coordinate activities to measure and improve appropriate antibiotic use in daily hospital practice. This thesis shows how the introduction of an antibiotic checklist as stewardship intervention involves frontline physicians in the aims of ASP. It is an intervention that can be used in different settings and requires limited resources. Use of the antibiotic checklist in daily hospital practice improved the appropriateness of antibiotic use defined by validated generic quality indicators. Although appropriate antibiotic use was associated with a reduction in length of stay, checklist use did not result in a reduction of length of stay. Non-adherence to the checklist items is the most probable explanation for this lack of effect. This thesis also illustrates that changing human behavior is challenging. When implementing an intervention, physicians’ agreement with the contents of the intervention, a healthcare leader as role model, and a survey to local barriers are crucial components for successful implementation of an intervention. Barrier identification before and during the use of an intervention is strongly recommended for optimization of the effect