Integrating staff nurses in antibiotic stewardship: Opportunities and barriers

Monsees, Elizabeth; Popejoy, Lori; Jackson, Mary Anne; Lee, Brian; Goldman, Jennifer L.

doi:10.1016/j.ajic.2018.03.028

Cited by 54 publications

(61 citation statements)

References 18 publications

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“… 23 30 Our findings also extend previous work in other settings, pointing to the unrecognised and underused role of nurses in governing antimicrobial usage, including leadership within ASPs. 44 45 As we have shown here and elsewhere, 24 25 the significance of nurses’ (seemingly informal) involvement and contributions to the broad improvement of practice in antimicrobial use is substantial. However, our findings serve as a reminder of the challenge of incorporating AMS into nursing workflow without simply attributing additional duties and responsibilities to nurses.…”

Section: Discussionmentioning

confidence: 71%

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

et al. 2020

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ObjectivesThis study responds to calls for greater focus on nursing roles, and the need for nursing integration within the antimicrobial optimisation agenda. The objective of this study was to explore Australian hospital nurses’ views on antimicrobial resistance and antimicrobial stewardship (AMS) in a hospital setting, in order to better understand the opportunities for and challenges to integration of nursing staff in antimicrobial optimisation within hospital settings.DesignQualitative one-on-one, semistructured interviews. Interview transcripts were digitally audio-recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.SettingFour hospitals (three public and one private), across metropolitan, regional and remote areas, in two Australian states.Participants86 nurses (77 females, 9 males), from a range of hospital departments, at a range of career stages.ResultsFindings were organised into three thematic domains: (1) the current peripheral role of nurses in AMS; (2) the importance of AMS as a collaborative effort, and current tensions around interprofessional roles and (3) how nurses can bolster antimicrobial optimisation within AMS and beyond.ConclusionNursing staff are central to infection management within the hospital and are thus ideally located to enhance antibiotic optimisation and contribute to AMS governance. However, without increased interprofessional cooperation, education and integration in the AMS agenda, as well as addressing organisational/resource constraints in the hospital, the nursing role in stewardship will remain limited.

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Section: Discussionmentioning

confidence: 71%

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

et al. 2020

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“…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.…”

Section: Hospital/local Stewardship Pediatric Nurses As Antimicrobialmentioning

confidence: 99%

“…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. 27,28 ASPs must concurrently work to promote behavioral modifications leading to improved antimicrobial utilizationand such efforts often require advocating for cultural change.…”

Section: Hospital/local Stewardship Pediatric Nurses As Antimicrobialmentioning

confidence: 99%

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

Klatte

2020

PHMT

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With the rapid growth of the field of pediatric antimicrobial stewardship, there has been a marked increase in the establishment of programs dedicated to this specialty. Shared objectives of all pediatric antimicrobial stewardship programs (ASPs) include optimization of antibiotic use and improvement in clinical outcomes for children, while certain core operational strategies and metrics used to measure program effectiveness are typically utilized by pediatric ASPs. Antimicrobial stewardship is the responsibility of every individual who prescribes, dispenses, and administers antibiotics to children, and pediatric ASP principles are rooted in collaboration and cooperation. Pediatric ASPs are uniquely suited to meet the needs of the local populations they serve and the environments within which they practice while also fostering an awareness of the interconnected global nature of pediatric stewardship. As such, pediatric ASPs are well positioned to confront the evolving challenges of antimicrobial overuse and resistance.

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“…Recent studies have shed light on nursing perceptions of their potential contribution to AS efforts in hospitals, their perceived limitations to accomplish their role as stewards, and suggestions to overcome these limitations. [9][10][11] When the role of bedside nurses in making AS interventions was examined, nurses reported a high degree of confidence with certain practices, such as assessing for antibiotic-associated adverse drug reactions, obtaining cultures prior to antibiotic initiation, and participating in patient and family education about appropriate antibiotic use. 9 Conversely, nurses were less confident or reluctant to initiate a 48-hour antibiotic time-out 9 or to de-label patients with penicillin (PCN) allergies.…”

Section: Existing As Work By Nursesmentioning

confidence: 99%

Integrating bedside nurses into antibiotic stewardship: A practical approach

Monsees

Tamma

Cosgrove

et al. 2019

Infect. Control Hosp. Epidemiol.

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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.

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Integrating staff nurses in antibiotic stewardship: Opportunities and barriers

Cited by 54 publications

References 18 publications

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

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

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

Integrating bedside nurses into antibiotic stewardship: A practical approach

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