Exploring the role of the ICU nurse in the antimicrobial stewardship team at a private hospital in KwaZulu-Natal, South Africa

Abstract

Background. Care of the critically ill patient has become increasingly challenging, with a rising incidence of resistant pathogens resulting in the ineffectiveness of many antibiotics. Severe infection is associated with prolonged intensive care unit (ICU) length of stay, and increased morbidity, mortality, and healthcare costs. Antimicrobial stewardship (AMS) aims to prevent resistance and protect patients and the wider community by promoting correct antimicrobial use. The current AMS literature has failed to describe the role of the ICU nurse in this important initiative. Objective. To explore the perceptions of AMS team members regarding the role of the ICU nurse in the AMS team. Methods. Using a qualitative research approach, purposive sampling was used to identify participants in an ICU. Semi-structured interviews were conducted with 15 participants, including ICU shift-leader nurses, nursing management, surgeons, anaesthetists, physicians, microbiologists and pharmacists. Data were analysed and categorised using content analysis. The study was conducted in a general ICU in the private healthcare sector in KwaZulu-Natal, South Africa. Results. Participants representing various disciplines of the AMS team felt that the role of the ICU nurse within the team was an important part of the AMS programme. Four categories that emerged from the data are discussed: organisational, advocacy, clinical and collaborative roles. Conclusion. The role of the ICU nurse was found to be essential to the success of AMS in the ICU. These findings provide implications for practice, which, if recognised and supported by all healthcare stakeholders from ICU and hospital management, could improve AMS in this acute care area. Globally, antimicrobial resistance has become one of the most important issues facing critical care. Resistance to antibiotics is escalating owing to overuse of antibiotics in the community and in hospitals, with increasing use of broad-spectrum antibiotics and delayed de-escalation practices.[1] Decreasing availability of antimicrobial therapy to treat complicated infections is attributed to the growing ineffectiveness of these medications due to increasing resistance, and the move of the pharmaceutical industry away from research and development of these products.[2] Therefore, it is becoming more difficult to manage infections in the very ill patient, resulting in prolonged intensive care unit (ICU) stay and increased mortality. [3] Antimicrobial stewardship (AMS) has developed as a proactive healthcare initiative to reduce antibiotic-selective pressure by promoting appropriate use of antimicrobial therapy and effective infection control. This is especially important in an ICU, which has the highest proportion of patients vulnerable to infection and uses the most antibiotics in the hospital setting.[4] Research into the prevalence of infection in private and public ICUs in South Africa (SA) found that, in the private ICU sector, an inappropriate antibiotic was prescribed in 60.8% of patients, duration of admi...

A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa

“…4: No discussion of recruitment criteria for interview No. 6: Lacking discussion of relationship between researchers and participants [ 31 ] Rout J The role of ICU nurses in antimicrobial stewardship at a South African private hospital 17 Healthcare professionals (doctors, nurses and pharmacists in ICU/surgery) 8/9 No. 6: Lacking discussion of relationship between researchers and participants [ 19 ] Torres NF Patterns of self-medication in Maputo city, Mozambique 49 Healthcare professionals (pharmacists) and pharmacy customers 9/9 No points lost [ 24 ] Agardh C Using pharmacists and drugstore workers as sexual healthcare workers among MSM in Dar es Salaam, Tanzania 15 Drugstore customers (men who have sex with men) 9/9 No points lost [ 29 ] Asante KP Knowledge of antibiotic resistance and prescription practices in the Brong Ahafo Region of Ghana 33 Healthcare professionals (doctors, physician assistants, nurses and community health officers) 8/9 No.…”

Advocacia do paciente pelos enfermeiros de terapia intensiva: uma revisão integrativa da literatura

“…Os estudos ainda apontam outras situações em que se fazem necessárias que o enfermeiro intensivista atue como defensor dos pacientes e familiares, como por exemplo: nas reuniões de família (Ahluwalia et al, 2015), nos aspectos que envolvem o paciente possível doador de órgãos (Forsberg et al, 2015), nas questões que permeiam a presença ou não da família dentro da UTI (Pasek & Licata, 2016), uso correto de antimicrobianos no tratamento de infecções (Rout & Brysiewicz, 2017), pacientes em fim de vida (Becker et al, 2017, Borowske, 2012, como também, perante uma internação por ordem judicial na UTI (Luz et al, 2019).…”

“…Ainda, o enfermeiro age como defensor do paciente, e ao mesmo tempo como articulador, no que diz respeito à terapêutica medicamentosa, quer seja para tratamento de infecções, quando o enfermeiro avalia a resposta do paciente ao tratamento com antibióticos, e discute a eficácia destes com o médico (Rout & Brysiewicz, 2017), quanto em relação aos cuidados do paciente em final de vida, quando faz a mediação junto ao médico, para que o paciente receba medicação adequada para o controle de sintomas agudos, e assim, possa ter uma morte pacífica (Becker et al, 2017).…”

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“…Specifically, the results suggested that the "role" of the nurse should include ensuring appropriate antimicrobial use (including the assurance of correct duration and prevention of overuse), a good working (and up to date) knowledge of antimicrobial guidelines, and education (e.g., educating colleagues and patients about use and challenging prescribing decisions). In a more focused setting, Rout and Brysiewicz (2017) highlighted the essential role of the intensive care unit (ICU) nurse within the AS team as vital to the success of AS in the ICU. The four categories found in the study were advocacy, organizational, clinical, and collaborative roles of the nurse.…”