The role of nurses in antimicrobial stewardship near the end of life in aged-care homes: A qualitative study

Dowson, Leslie; Friedman, N. Deborah; Marshall, Caroline; Stuart, Rhonda L.; Buising, Kirsty; Rajkhowa, Arjun; Gotterson, Fiona; Kong, David Chee Ming

doi:10.1016/j.ijnurstu.2019.103502

Cited by 8 publications

(11 citation statements)

References 24 publications

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“…(6,8,23,24) Estudos apontam que é necessário delinear a microbiota local com perfis de suscetibilidade a antimicrobianos para realizar o gerenciamento de casos em equipe nos diferentes serviços de saúde. (23)(24)(25) Mesmo com escassas pesquisas e propostas de programas de controle de infecção e vigilância epidemiológica, entende-se que as Instituições de Longa Permanência para Idosos devam seguir a mesma prerrogativa.…”

Section: Discussionunclassified

“…Por meio do acompanhamento do idoso, é possível discutir o descalonamento, que é o estreitamento do espectro antimicrobiano orientado pela suscetibilidade do patógeno. (25) O processo de descalonamento é interdisciplinar e promove a discussão dos casos entre o prescritor médico e o enfermeiro, com intuito de reduzir as possibilidades de gerar resistência bacteriana, diminuir custos de tratamento e minimizar situações teratogênicas no idoso. (25)(26)(27) Dessa forma, considera--se que os resultados desse estudo contribuam para melhorar a racionalidade nas prescrições, monitoramento dos casos e constituição da cultura de vigilância em saúde local.…”

Section: Discussionunclassified

See 1 more Smart Citation

Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos

Silva¹,

Silva²,

Ferreira³

et al. 2022

Acta Paulista De Enfermagem

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Conflitos de interesse: nada a declarar. ResumoObjetivo: Caracterizar os microrganismos e sua suscetibilidade antimicrobiana em uroculturas de idosos residentes de uma instituição de longa permanência. Métodos: Estudo observacional transversal com 116 indivíduos de uma Instituição de Longa Permanência para Idosos de um município do sul da Bahia. O estudo foi aprovado por Comitê de Ética em Pesquisa e utilizou-se Termo de Consentimento Livre e Esclarecido. Foram realizadas coleta e análise laboratorial de urina tipo I e urocultura. Realizaram-se testes de sensibilidade a antimicrobianos conforme os critérios do European Committee on Antimicrobial Susceptibility Testing. Para o diagnóstico de infecção do trato urinário, foram utilizados os critérios de McGeer. A análise de dados se deu por estatística descritiva, com frequências absolutas e relativas.Resultados: A prevalência de infecção do trato urinário foi de 33,62%, com predominância no sexo feminino e idade acima de 80 anos. Os uropatógenos foram: 69,2% Escherichia coli, 20,6% Klebsiella pneumoniae e 5,1% Providencia stuartii e Acinetobacter baumannii. As cepas de E. coli apresentaram suscetibilidade para a maior parte dos antimicrobianos; já nas de K. pneumoniae, a suscetibilidade foi variável. P. stuartii e A. baumannii não apresentaram resistência a carbapenêmicos e aos betalactâmicos aztreonam e piperacilina associados a tazobactam.Conclusão: As cepas mais prevalentes e o perfil de suscetibilidade seguiram padrão próximo ao hospitalar, o que implica a necessidade de a instituição promover melhores estratégias de controle de infecção e envolver a equipe de enfermagem no gerenciamento dos casos e na qualificação da prescrição antimicrobiana, para reduzir a resistência bacteriana e efeitos adversos nos idosos.

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Section: Discussionunclassified

Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos

Silva¹,

Silva²,

Ferreira³

et al. 2022

Acta Paulista De Enfermagem

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“…However, a good understanding of antibiotics, AMR and AMS is needed to effectively embed these concepts in clinical practice. Hence, addressing these educational needs is of paramount importance Qualitative studies Dowson et al [ 27 ] Victoria (Australia) One-on-one, semi-structured, qualitative interviews Health professionals (i.e., nurses, general practitioners and pharmacists) working in aged-care homes in Victoria, Australia (i) Describe health professionals’ perspectives on antimicrobial use near the end of life in aged-care homes. (ii) Investigate the potential opportunities for nurses to undertake antimicrobial stewardship activities near the end of life in aged-care homes RNs.…”

Section: Data Extractionmentioning

confidence: 99%

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Danielis

Regano

Castaldo

et al. 2022

Antimicrob Resist Infect Control

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Background Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients’ bedside, the aim of the present study was to examine recent literature on nursing competency in AMS. Methods Drawing from Tricco and colleagues’ seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding. Results Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes. Conclusion This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.

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“…Residents in the final month of life are increasingly likely to be prescribed an antimicrobial, commonly without having signs and symptoms of infection. Dowson et al 105 , 106 described the perspectives of health professionals on antimicrobial use near the end of life (EoL) in ACHs and investigated the potential opportunities for AMS activities. Interviews were conducted with nurses, GPs and pharmacists with a diversity of years of experience in providing routine care to residents of ACHs in Victoria in different facility locations (metropolitan and rural) and types (public and private).…”

Section: Aged Carementioning

confidence: 99%

“…Reported workflow-based challenges in ACHs included limited on-site staff resources and the use of multiple off-site care providers. 106 Opportunities for ACH nurses to undertake AMS activities near the EoL in the provision of routine care were identified. Support for ACH nurses to make decisions substantiated by evidence-based clinical teaching and through improved care coordination relating to infection management was highlighted as a potential facilitator of AMS involvement.…”

Section: Aged Carementioning

confidence: 99%

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

Thursky

Hardefeldt

Rajkhowa

et al. 2021

JAC-Antimicrobial Resistance

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Antimicrobial stewardship (AMS) in Australia is supported by a number of factors, including enabling national policies, sectoral clinical governance frameworks and surveillance programmes, clinician-led educational initiatives and health services research. A One Health research programme undertaken by the National Centre for Antimicrobial Stewardship (NCAS) in Australia has combined antimicrobial prescribing surveillance with qualitative research focused on developing antimicrobial use-related situational analyses and scoping AMS implementation options across healthcare settings, including metropolitan hospitals, regional and rural hospitals, aged care homes, general practice clinics and companion animal and agricultural veterinary practices. Qualitative research involving clinicians across these diverse settings in Australia has contributed to improved understanding of contextual factors that influence antimicrobial prescribing, and barriers and facilitators of AMS implementation. This body of research has been underpinned by a commitment to supplementing ‘big data’ on antimicrobial prescribing practices, where available, with knowledge of the sociocultural, technical, environmental and other factors that shape prescribing behaviours. NCAS provided a unique opportunity for exchange and cross-pollination across the human and animal health programme domains. It has facilitated synergistic approaches to AMS research and education, and implementation of resources and stewardship activities. The NCAS programme aimed to synergistically combine quantitative and qualitative approaches to AMS research. In this article, we describe the qualitative findings of the first 5 years.

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The role of nurses in antimicrobial stewardship near the end of life in aged-care homes: A qualitative study

Cited by 8 publications

References 24 publications

Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos

Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

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