European Commission guidelines for the prudent use of antimicrobials in human health: a missed opportunity to embrace nursing participation in stewardship

Castro-Sánchez, Enrique; Bennasar‐Veny, Miquel; Smith, M. Brewster; Singleton, S.; Bennett, Emily; Appleton, Janet; Hamilton, Nykoma; McEwen, J.; Gallagher, Rose

doi:10.1016/j.cmi.2018.02.030

Cited by 14 publications

(11 citation statements)

References 3 publications

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“…Yet, this ME identified an absence of perceived or reported nursing involvement in antibiotic decision-making. This may reflect perceptions about antibiotic prescribing as a process that requires increased knowledge only exclusive to medical professionals with prescribing powers [ 62 ], existing and gaps in undergraduate and postgraduate education about antibiotics and AMR [ 63 ]. Yet, it remains essential to maximise the contribution of the existing professionals outside infection disease and microbiology towards appropriate use of antimicrobials [ 64 ], especially in view of the new Nursing and Midwifery Council guidance highlighting that newly qualified nurses have to be prepared to undertake prescribing training soon after registration [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography

et al. 2021

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Background Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has contributed to this problem and evidence-based interventions are urgently needed to change inappropriate prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic prescribing in hospitals through design of an effective behaviour-change intervention. Methods Qualitative synthesis using meta-ethnography of primary studies reporting doctors’ views and experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty electronic databases were systematically searched over a 10-year period and potential studies screened against eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working independently with findings discussed with the wider team and key stakeholders. Studies were related by findings into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and conceptual model. Findings are reported using eMERGe guidance. Results Fifteen papers (13 studies) conducted between 2007 and 2017 reporting the experiences of 336 doctors of varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals: loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level, highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms, normalising input from other specialties and reducing variation in responsibility for antibiotic decisions. Conclusions This first meta-ethnography of doctors` experiences of antibiotic prescribing in acute hospital settings has enabled development of a novel conceptual model enhancing understanding of appropriate antibiotic prescribing. That is, hospital antibiotic prescribing is a complex, context-dependent and dynamic process, entailing the balancing of many tensions. To change practice, comprehensive efforts are needed to manage failures in communication and information provision, promote distribution of responsibility for antibiotic decisions, and reduce fear of consequences from not prescribing. Trial registration PROSPERO registration: CRD42017073740.

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Section: Discussionmentioning

confidence: 99%

Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography

et al. 2021

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“…Yet, this ME identi ed an absence of perceived or reported nursing involvement in antibiotic decision-making. This may re ect perceptions about antibiotic prescribing as a process that requires increased knowledge only exclusive to medical professionals with prescribing powers [62], to existing gaps in undergraduate and postgraduate education about antibiotics and AMR [63]. Yet, it remains essential to maximise the contribution of the existing professionals outside infection disease and microbiology towards appropriate use of antimicrobials [64], especially in view of the new Nursing and Midwifery Council guidance highlighting that newly quali ed nurses have to be prepared to undertake prescribing training soon after registration [65].…”

Section: Line-of-argument Synthesismentioning

confidence: 99%

“Understanding the Complexities of Antibiotic Prescribing Behaviour in Acute Hospitals: A Systematic Review and Meta-Ethnography”

Wojcik

Ring

McCulloch

et al. 2021

Preprint

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Background Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has contributed to this problem and evidence-based interventions are urgently needed to change inappropriate prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic prescribing in hospitals through design of an effective behaviour-change intervention. Methods Qualitative synthesis using meta-ethnography of primary studies reporting doctors’ views and experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty electronic databases were systematically searched over a 10-year period and potential studies screened against eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working independently with findings discussed with the wider team and key stakeholders. Studies were related by findings into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and conceptual model. Findings are reported using eMERGe guidance. Results Fifteen papers (13 studies) conducted between 2007–2017 reporting the experiences of 336 doctors of varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals: loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level, highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms, normalising input from other specialties and reducing variation in responsibility for antibiotic decisions. Conclusions This first meta-ethnography of doctors` experiences of antibiotic prescribing in acute hospital settings has enabled development of a novel conceptual model enhancing understanding of appropriate antibiotic prescribing. That is, hospital antibiotic prescribing is a complex, context-dependent and dynamic process, entailing the balancing of many tensions. To change practice, comprehensive efforts are needed to manage failures in communication and information provision, promote distribution of responsibility for antibiotic decisions, and reduce fear of consequences from not prescribing.

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“…Finally, we acknowledge that these competency descriptors focus largely on clinical and bed-side aspects, and may be further expanded and refined to explore other elements centred on leadership [48] or executive and even political [49] skills that may be increasingly seen as essential to enable clinical competence. As AMR is recognised as a global and planetary matter driven by broad social determinants [50], such leadership skills may also be progressively adopted.…”

Section: Study Limitationsmentioning

confidence: 99%

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

Courtenay

Castro-Sánchez

Gallagher

et al. 2019

Journal of Hospital Infection

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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.

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European Commission guidelines for the prudent use of antimicrobials in human health: a missed opportunity to embrace nursing participation in stewardship

Cited by 14 publications

References 3 publications

Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography

Understanding the complexities of antibiotic prescribing behaviour in acute hospitals: a systematic review and meta-ethnography

“Understanding the Complexities of Antibiotic Prescribing Behaviour in Acute Hospitals: A Systematic Review and Meta-Ethnography”

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

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