Table 2.

Themes Constructed From the Data

Theme	Illustrative Quotation
Antimicrobial consumption perceived as a proxy measure for antimicrobial prescribing quality	“I suppose the things that we would be broadly interested in is obviously volume of prescriptions.”—Attending surgeon “It means, if there is a buy-in of less IV antibiotics, everyone and their mother will look it (feedback) all up and do everything and hound this doc and that doc. If it means less IVs and preparing IVs and giving IVs…”—Clinical nurse manager
Lack of connection between antimicrobial prescribing and patient outcomes	“Just what’s relevant to us… I want MY report…”—Attending physician “And from a stewardship point of view, different wards that are more inclined to use…antibiotics that we wouldn’t necessarily associate with being first line so…”—Medical resident “Why did we spend that much? Oh, because there were 7 patients on the ward and were incredibly sick. I think it (feedback) would have to be externally provided but internally checked.”—Attending surgeon
Relevance and impact of antimicrobial prescribing feedback associated with professional role	“It (feedback) should be available for everybody that wants to access it. Well, I think! Why would it not be?” Clinical nurse specialist. “… It will change your daily practice once you’ve kinda like, once, em, you can kind of reflect on it.”—Medical resident “We can keep hounding attendings and sure, we’re at nothing.”—Clinical nurse manager “I think sometimes, as well, when you don’t have senior decision makers on the ward rounds… There are no decisions made. And may not be made for 5 days!”—Clinical nurse manager “… The (medication administration) timings, and then that’s a nursing perspective that we can govern.”—Clinical nurse manager “… A resistant organism would be a reason for prescribing something that you wouldn’t normally prescribe for that indication.”—Medical resident “But looking at the number of people in the hospital who have … an antibiotic allergy, and then looking up what they’re on ….”—Attending physician
Attitudes toward feedback as an AMS strategy	“Oh, I think they (attendings) would be very positive. I mean from our perspective, we don’t handle very well somebody telling us we are not very good at operations. But we’re very good when somebody is saying you could do this (antibiotic prescribing) better.”—Attending surgeon “So when you’re prescribing too many quinolones or whatever, you need to stop doing that so it’s a slap on the wrist type of stuff is it?”—Attending physician. “You know because there are so many new things coming into the hospital, there are so many things you have to follow up on, so many things you have to do.”—Clinical nurse manager. “It’s about interpreting the data. I think if we were looking at it by ourselves what would very quickly happen is that people would go, oh that’s very interesting but I’m not sure if it’s actually relevant. We’d need context.”—Attending surgeon “So, once it’s presented at grand rounds, or like whatever, all the findings and then it kind of seeps into your mentality rather than on a daily basis on the round…that’s important.”—Medical resident “I’d use it in their (resident) training, I suppose along with the allergy and you could have other specific topics that … the residents being kept up to date on.”—Attending physician “… We’ll have a captive audience in our monthly morbidity and mortality meeting where ward staff, interns, residents, all of us sit together, look at our numbers and discuss in that…”—Attending physician
Knowledge regarding AMS, including antimicrobial prescribing quality measures	“Like, for me waiting list times and times to scan, I’m monitoring that myself cos it’s relevant to me. I’m not going to go looking for antibiotic data.”—Attending physician “Length of stay and, em, discharge lounge use … transfers out of ICU…”—Clinical nurse manager “We need to understand these KPIs (key performance indicators) better. Like you know, compliance with duration of agent with local policy. I don’t know what it is.”—Clinical nurse manager “Am, so I think people might not be aware that their prescribing, or their team’s prescribing is out of keeping.”—Medical resident “Because I think that what you’d find … that it (feedback) was only being accessed by those who were interested in antimicrobial prescribing.”—Medical resident “I know without looking anything up, what specialty will have the wrong antibiotic for a very prolonged period of time, you know? So it’s just recurrent. But it is very much people’s user preference. It’s hard to change that.”—Clinical nurse specialist “And I mean people who are in subspecialty areas … would I’m sure prescribe off label a lot more. So (feedback) is probably more relevant to those individuals.”—Attending physician