Table 2 Capability themes and key quotes

Varied antimicrobial knowledge and experience

“[prescribing doctors’] previous experience is very vital… So how often they do use antibiotics. Oncologists have a long history, they’ve got a lot more association with antibiotics than our surgical colleagues, some surgical colleagues still use very old-fashioned approaches to antibiotics and they tend not to keep as up to date as they perhaps should.” (Clinical Microbiologist 1, FG1)

“I work in orthopaedics so we have a lot of resistance… even in the last 12 to 24 months we see a lot more coming through… resistance to multiple things and other infections occurring in patients’ wounds.” (NUM 2, FG3)

“NUM2: I remember when we first got out first VRE patient on the orthopaedic unit, and it would have been probably 9 or 10 years ago…. [now] it’s kind of like everyone seems to have VRE

NUM3: Everyone, I know! … it’s like the boy who cried wolf. It doesn’t shock you anymore.” (FG3)

“I know that there are certain antibiotics that I personally shouldn’t prescribe, that are beyond my ability, so I have a low threshold to get an infectious diseases physician involved for anything out of my depth” (Cardiologist, FG2)

Staff understand the theory of AMS

“My understanding of it is… it’s maybe multidisciplinary involving infectious disease physicians, nurses, and pharmacy sort of taking responsibility for appropriate guidelines and overseeing management of antibiotic use in the hospital. That’s my simple view of it.” (Anaesthetist, FG2)

“I’m very much aware of the relevance of the problem currently with resistance and lots of different programs either within hospitals or nationally and even internationally to try and reduce said infections that are resistant to standard therapy. I think it’s something that they, I think that even though there is lots of talk about it, the significance is still underplayed.” (Pharmacist, FG3)

Staff have limited knowledge of the hospital’s AMS program

“I think it probably, there would be fair to say there’s some confusion over an infectious diseases specialist seeing someone they’ve been referred to versus an infectious disease doctor doing an AMS round? Like looking at it from a stewardship point of view rather than, from a “I’ve been referred to see a complex patient”.” (Pharmacists, FG3)

“You know who [the AMS team] are. But I guess like, you don’t know how they got there. If that makes sense. Were they referred? How do they know? I don’t know that. … Like how do they know to come to bed 54 when like, maybe there’s another 6 patients on antibiotics and you kind of think “oh why are they on vancomycin”.” (NUM 2, FG3)

“Do we or don’t we? [laughs] I’m not even sure if we have [an AMS program]” (Cardiologist, FG 2)