Table 3.

Implementation Outcomes and Emerging Codes Associated with Change and Adoption of Evidence-Based Practices

Acceptability, adoption, resistance to change, local culture	There are people who buy into (stopping antibiotics) and there are people who don’t buy into it… They don’t believe the data for stopping antibiotics is robust.
Acceptability, fidelity, knowledge, medical training, anchoring, normative behaviors and local culture, processes	For antibiotics, typically we have not been giving post-procedure antibiotics to the bulk of the patients. Some patients who are deemed to be high risk by the treating physician will be given post procedure antibiotics, but that is relatively rare. In fellowship, we were treating everybody with a standard course of antibiotics, usually for about 3 days for a de novo implant and then 5–7 days for a generator change. That was standard. But, when I came to practice, they [the other providers in my new practice] had moved away from that [giving antibiotics post-procedure]. In fellowship, there was talk about moving away from it, but there was not a lot of consensus. When I came to the new practice, there was sort of a protocol in place… most people had not been doing it. That made stopping easy. It was definitely a change. It has been something that has been on our minds for a while from a stewardship and patient safety perspective… and I was interested in probably giving it up before I left fellowship. It was nice to come to a place where people were doing it routinely so I could make that shift. Definitely facilitated the change to come to a place where people were already doing it.
Acceptability, fidelity, standardization, normative behavior, knowledge	Where I trained, everyone got 3 days for a new implant and 7 days for generator changes. When I joined my practice, I gave no orals and I have not noticed any changes in my infection rates. Also, there is really no evidence to support it in EP. You will find wide variation in that, how people deal with antibiotics after implants. I just followed practice patterns at my new place, to keep things simple and to make it easy for the staff. I also made the change based on their low infection rates even though they were not using post-op antibiotics. There’s really no evidence for it in EP and looking at the data from orthopedics and also surgical data, that really shows that for surgical site infections, it’s preoperative antibiotics and not necessarily post-procedure antibiotics, but I admit that I am not familiar with that data. I would say that overall, half give, half don’t. Where I trained, it is still pretty common.