Development of consensus-based international antimicrobial stewardship competencies for undergraduate nurse education

Abstract

Background: There is growing recognition by national and international policy makers of the contribution nurses make towards antimicrobial stewardship. Although undergraduate education provides an ideal opportunity to prepare nurses for antimicrobial stewardship roles and activities, only two thirds of undergraduate nursing programmes incorporate any antimicrobial stewardship teaching and only 12% cover all the recommended antimicrobial stewardship principles. Nurses also report that they do not have a good knowledge of antibiotics, and many have not heard of the term antimicrobial stewardship. Aim: To provide international consensus on the antimicrobial stewardship competency descriptors appropriate for undergraduate nurse education. Methods: A modified Delphi approach comprising two on-line surveys delivered to an international panel of fifteen individuals reflecting expertise in prescribing and medicines management in the education and practice of nurses; and antimicrobial stewardship. Data collection took place between February and March 2019. Findings: A total of 15 participants agreed to become members of the expert panel, of whom 13 (86%) completed round one questionnaire, and 13 (100%) completed round two. Consensus was achieved, with consistent high levels of agreement across panel members, on 6 overarching competency domains and 63 descriptors, essential for antimicrobial stewardship practice. Conclusion: The competency descriptors should be used to direct undergraduate nurse education, and the AMS practices of qualified nurses (including those working in new roles such as Nursing Associates) given the high levels of agreement reached on competency descriptors.

Diversity in health professional education scholarship: a document analysis of international author representation in leading journals

“…Across many disciplines and medical subspecialties, curricular reform and international standardisation of competencies are increasingly pursued, but risk disproportionate emphasis on regional values and practices. [18][19][20][21] Experiences and innovations from small or remote environments may in fact transfer more readily to certain Western contexts, especially where healthcare systems face comparable challenges (eg, medication shortages, inadequate supplies, ageing infrastructures, insufficient recruitment and retention of necessary personnel). Issues around the globalisation of HPE have been typically oriented towards the mobilisation of curricula and healthcare workforce across borders, but must also attend to patients themselves.…”

Antimicrobial stewardship: a competency framework to support the role of nurses

“…To address the gap in antimicrobial stewardship teaching in undergraduate nurse education, and to support healthcare professionals who are new to roles for which an understanding of antimicrobial stewardship is important, an antimicrobial stewardship competency framework has been developed (Courtenay et al 2019a). This framework, which has been endorsed by NICE (NICE 2020), can be used to support nurse education and nursing practice, ensuring that nurses, nursing associates and nursing students have the knowledge and skills they need to act against antimicrobial resistance.…”

“…Each domain is linked with an overall competency statement and 5-18 competency descriptors, which detail how nurses, nursing associates and nursing students can demonstrate competency in each domain (Courtenay et al 2019a). For example, to demonstrate competency in infection prevention and control, learners must be able to explain what an antimicrobial-resistant organism is (competency descriptor 3) and demonstrate an understanding of the importance of surveillance (competency descriptor 8).…”

Preparing nurses for COVID-19 response efforts through involvement in antimicrobial stewardship programmes

“…It is reported that nurses' knowledge of antibiotics is poor [11,12], and that AMS taught in nurse undergraduate programmes is disparate or lacking [13]. To address this gap, AMS consensus-based international competency statements have been developed, focused on six domains (infection prevention and control, antimicrobials and antimicrobial resistance, the diagnosis of infection and use of antibiotics, antimicrobial prescribing practice, person-centred care, interprofessional collaborative practice), which are (seen as) priorities/minimum requirements for nurses [14,15].…”

“…This awareness is central to reducing unnecessary prescriptions of not just antibiotics, as COVID-19 is caused by a virus, but other anti-infective drugs associated with AMS such as antifungal and antiviral medications. AMS requires nurses to be able to distinguish between symptoms and ask questions about the use of antibiotics, should symptoms be more consistent with a viral infection, or when microbiology results do not indicate a bacterial cause [14]. Such actions will help to ensure that antimicrobial resistance is not an unintended consequence of COVID-19.…”