Participatory eHealth development to support nurses in antimicrobial stewardship

Abstract

BackgroundAntimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses’ can be supported in ASPs by means of an eHealth intervention that targets their information needs.MethodsWe applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital.ResultsTo perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application’s functionality, content, and structure to nurse work practice and tasks.ConclusionsBy applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses’) and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspectives.

Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists

“…However, other healthcare workers also play an important role in AMS at the individual patient level including junior and senior doctors, nurses, non-medical prescribers and ward pharmacists. [36][37][38][39][40][41] Inclusion of these professional groups in user-testing at the design stage of EPMA implementation is likely to be critical to the success of the proposed software features. Future surveys focussing on front-line prescribers and medication administrators are critical.…”

Residual volume in vials of antibiotics used in pediatrics

“…The waste of antibiotics evidenced by the existence of residual volume reinforces another worrying finding, which is the inadequate disposal of the vials containing residual volumes of medicines. Such disposal represents a potential risk of contributing to antimicrobial resistance (15) , which is a threat to patient safety around the world (16) . Nurses also play an important role in the management of waste disposal, which may pose a risk to public health and to the environment (17) .…”

A multifaceted intervention to reduce antimicrobial prescribing in care homes: a non-randomised feasibility study and process evaluation

“…In order to facilitate as many staff as possible, other modes of delivery of the presentation were also made available. Access to up-to-date and easily accessible information was found to be important in supporting hospital-based nurses in antimicrobial stewardship programmes, 4,88 and required the development of a specific app (application). We supplied the training material in a number of formats to facilitate access, and staff were also given a copy of the study handbook.…”