Integrating bedside nurses into antibiotic stewardship: A practical approach

Abstract

Nurses view patient safety as an essential component of their work and have reported a general interest in embracing an antibiotic steward role. However, antibiotic stewardship (AS) functions have not been formally integrated into nursing practice despite nurses’ daily involvement in clinical activities that impact antibiotic decisions (e.g., obtaining specimens for cultures, blood drawing for therapeutic drug monitoring). Recommendations to expand AS programs to include bedside nurses are generating support at a national level, yet a practical guidance on how nurses can be involved in AS activities is lacking. In this review, we provide a framework identifying selected practices where nurses can improve antibiotic prescribing practices through appropriate obtainment of Clostridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation of penicillin allergy histories and through the prompting of antibiotic time outs. We identify reported barriers to engagement of nurses in AS and offer potential solutions that include patient safety principles and quality improvement strategies that can be used to mitigate participation barriers. This review will assist AS leaders interested in advancing the contributions of nurses into their AS programs by discussing education, communication, improvement models, and workflow integration enhancements that strengthen systems to support nurses as valued partners in AS efforts.

Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

“… 34 Expanding AMS to better empower nurses is crucial to ongoing attempts to curb the threat of AMR by improving judicious use of antimicrobials. 22 23 50 52 Moreover, improving our understanding of the experiences of nurses will enable meaningful improvements in AMS activities through contributing interdisciplinary knowledge and expertise and leveraging nursing skills and expertise. 22 23 52 …”

“… 22 23 50 52 Moreover, improving our understanding of the experiences of nurses will enable meaningful improvements in AMS activities through contributing interdisciplinary knowledge and expertise and leveraging nursing skills and expertise. 22 23 52 …”

“…Despite the relative lack of research attention on nursing and antimicrobial optimisation, recent studies have underscored the less visible aspects of everyday work already done by nurses to influence antimicrobial prescribing and use within hospitals. 22–24 Nurses’ presence on the ward and their responsibilities for patient monitoring and advocacy highlight their relevance in terms of detection and documentation of changes to a patient’s condition. 17 23 25 Research has revealed the instrumental roles played by nurses in communication and management of antimicrobials, for example, in prompting, reminding, checking and querying prescribers’ decisions.…”

“… 23 Another factor is the lack of clarity around the role of nursing in antimicrobial decision-making and ‘medical prescribing’, with nurses often situated as ancillary to medical and pharmacy expertise and authority. 17 24 32 Monsees et al , for example, 22 found that nursing involvement in AMS was often viewed as interfering with the decisions of (medical) prescribers. Such research points to how professional dynamics are inherent to practice, and serves as a reminder of the on-going significance of addressing professional relations and hierarchies in implementing practice change around key issues such as antimicrobial misuse.…”

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

“…23,24 Duties such as obtaining and recording accurate allergy histories, ensuring antibiotic administration at proper dosages and times, and facilitating timely IV to oral therapy conversion are just some of the many ways through which bedside nurses actively impact AS. 25,26 Accordingly, most nurses agree that formal incorporation into ASPs is not only welcome but necessary. 21,22,25 Implementation, maintenance, and growth of successful ASPs require a willingness to understand and have a flexible mindset about certain cultural norms, including those specific to individual hospitals, medical specialties, and to the hierarchical culture of medicine.…”