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Bridey C, Bocquier A, Bonnay S, Pulcini C, Thilly N. Nursing home nurses' opinions on the potential evolution of their role in antibiotic stewardship: A French national cross-sectional survey. J Clin Nurs 2024; 33:1849-1861. [PMID: 38093495 DOI: 10.1111/jocn.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/05/2023] [Accepted: 11/27/2023] [Indexed: 04/04/2024]
Abstract
AIMS To assess French nursing home nurses' opinions on the potential evolution of their antibiotic stewardship role, facilitators and barriers, and nurses' characteristics associated with their opinion toward new roles regarding antibiotic prescribing. DESIGN We conducted a cross-sectional study in French nursing homes with ≥20 beds and for which an email address was available in a national database managed by the French government between May and June 2022. METHODS A self-administered internet-based questionnaire of 43 closed-ended Likert items was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Data analysis included descriptive statistics and χ2 tests. RESULTS 7215 nursing homes were sent the online questionnaire; 1090 participants completed it partially or totally and 923 fully filled in the questionnaire. A majority of nurses supported strengthening and expanding their antibiotic stewardship role. Regarding new roles, over 70% agreed that nurses could collect urine samples to perform a urine culture on their own initiative, prescribe microbiological laboratory tests, and change the drug formulation or the administration route of the antibiotic prescribed by the general practitioner. One-third declared that they could initiate antibiotics for some infections and/or change the empirical antibiotic treatment prescribed by the general practitioner. Nurses from public nursing homes with connection to a hospital (27.5% vs. >35% for other status) and with recent experience in nursing homes (31% for <5 years of practice vs. 41% for 10 years or more) were less likely to agree to prescribe antibiotics. CONCLUSIONS This quantitative questionnaire survey identified potential new nurses' roles in antibiotic stewardship that seem to be acceptable and feasible for participants. These new nurses' roles need to be explored in future experimentations before considering implementation. REPORTING METHOD The study adhered to relevant EQUATOR guidelines and followed the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION A self-administered internet-based questionnaire was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Nurses and head nurses who were interested and willing could complete the questionnaire online partially or fully. TRIAL AND PROTOCOL REGISTRATION This study is not a clinical trial and is not eligible for trial registration. We used another suitable study registration site, the Center for Open Science.
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Affiliation(s)
| | | | | | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France
- Centre régional en antibiothérapie du Grand Est AntibioEst, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, Nancy, France
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Glarcher M, Vaismoradi M. A systematic integrative review of specialized nurses' role to establish a culture of patient safety: A modelling perspective. J Adv Nurs 2024. [PMID: 38366739 DOI: 10.1111/jan.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
AIMS To understand specialized nurses' role in the culture of patient safety and their ability to promote and enforce it within healthcare. DESIGN A systematic integrative review using the approach of Whittemore and Knafl. METHODS Systematic literature search for qualitative, quantitative and mixed-methods studies, followed by data evaluation, quality assessment, analysis and research synthesis with a narrative perspective. Findings were contextualized within a 'framework for understanding the development of patient safety culture'. DATA SOURCES Searches were conducted in PubMed [including MEDLINE], Scopus, CINAHL, Web of Science and EMBASE from Jan 2013 until Sep 2023. RESULTS Sixteen studies published in English from six different countries were selected and used for research synthesis. Diverse enabling factors and enacting behaviours influencing specialized nurses' roles to promote patient safety culture were identified, mainly focusing on nurses' workload, professional experiences and organizational commitment. Patient safety outcomes focused on medication management, infection prevention, surveillance process in critical care, oversight on quality and safety of nurses' practice, patient care management, continuity of care, adherence to the treatment plan and implementation of a specialized therapeutic procedure. CONCLUSION Specialized nurses can make a significant contribution to promote patient safety culture and support organizational initiatives to prevent adverse events. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Stronger participation and leadership of specialized nurses in initiatives to improve patient safety culture requires appropriate investments and support by policy makers and managers in terms of resources and training. IMPACT There is a gap in existing literature on the contribution that specialized nurses can make in promoting patient safety culture. Review results highlight the importance of interprofessional collaboration and teamwork by involving specialized nurses. They inform healthcare policy makers about recognizing their roles and competencies in patient safety culture. Preferred reporting items for systematic reviews and meta-analysis. No patient or public contribution.
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Affiliation(s)
- Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, New South Wales, Australia
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Lim J, Bang KS. Participation in and perceptions of antibiotic stewardship behaviors among nurses at a children's hospital in South Korea: a descriptive study. CHILD HEALTH NURSING RESEARCH 2024; 30:54-66. [PMID: 38302272 PMCID: PMC10834308 DOI: 10.4094/chnr.2023.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
PURPOSE This study investigated participation in and perceptions of antibiotic stewardship among nurses at a children's hospital. METHODS This descriptive study included 125 nurses working in the inpatient ward, intensive care unit and emergency room of a single tertiary children's hospital. The study measured 14 factors influencing antibiotic stewardship behaviors using the theoretical domains framework. Each factor was analyzed by categorizing it into components (capability, opportunity, and motivation) that have been proposed as influencing factors in the COM-B model of behavior. One-way analysis of variance and Pearson correlation coefficients were used to explore differences in antibiotic stewardship behaviors and influencing factors according to general characteristics and the correlation between antibiotic stewardship behaviors and COM-B components. RESULTS No statistically significant difference in antibiotic stewardship behaviors was found based on the experience of antibiotic stewardship education or the nursing department. However, significant differences were observed in the perception levels of factors related to antibiotic stewardship behaviors according to the experience of antibiotic stewardship education in skill (physical) (p=.042), knowledge (p=.027), intentions (p=.028), and social influences (p=.010). Additionally, significant differences were observed in perception levels according to the sub-components of the COM-B model, specifically physical capability (p=.042), psychological capability (p=.027), and social opportunity (p=.010). CONCLUSION To expand nurses' involvement and roles in antibiotic stewardship, nurses should acknowledge the significance of appropriate antibiotic use, aiming to enhance the quality of medical care and ensure patient safety. In pursuit of this objective, tailored education aligning with the specific needs and practices of nurses is essential.
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Affiliation(s)
- Jihee Lim
- Doctoral Candidate, College of Nursing, Seoul National University, Seoul, Korea
| | - Kyung-Sook Bang
- Professor, College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use. JAC Antimicrob Resist 2023; 5:dlad123. [PMID: 38021036 PMCID: PMC10667038 DOI: 10.1093/jacamr/dlad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities. Conclusions Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
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Affiliation(s)
- Maria Bos
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cindy De Bot
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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Padigos J, Reid S, Kirby E, Anstey C, Broom J. Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey. Aust Crit Care 2023; 36:769-781. [PMID: 36404269 DOI: 10.1016/j.aucc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied. OBJECTIVE The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia. METHODS An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated. RESULTS A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement. CONCLUSION The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.
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Affiliation(s)
- Junel Padigos
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Simon Reid
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney NSW, 2052, Australia
| | - Chris Anstey
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jennifer Broom
- Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
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Zhao W, Guo W, Sun P, Yang Y, Ning Y, Liu R, Xu Y, Li S, Shang L. Bedside nurses' antimicrobial stewardship practice scope and competencies in acute hospital settings: A scoping review. J Clin Nurs 2023; 32:6061-6088. [PMID: 37186422 DOI: 10.1111/jocn.16731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/15/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
AIM To identify and map bedside nurses' practice scope and competencies regarding antimicrobial stewardship in acute hospital settings, and develop a competency framework for them. BACKGROUND Antimicrobial stewardship requires multidisciplinary engagement including nursing. However, bedside nurses' antimicrobial stewardship practice scope and competencies in acute hospital settings remain unclear. DESIGN Scoping review. METHODS Using a five-stage framework proposed by Arksey and O'Malley and following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS A total of 1422 records were retrieved, and 41 studies were included. In addition to the six practices recommended, this review summarized bedside nurses' contributions to five additional fields as well. Correspondingly, the competencies required by bedside nurses were summarized into eight domains: specialized knowledge, safety medication administration, leadership, education, diagnostic stewardship, infection prevention and control, professional development and professional quality. CONCLUSION Nurses' practice scope overlaps greatly with routine nursing practice in antimicrobial stewardship, confirming the evidence that nurses are ideal partners in antimicrobial stewardship. This review developed a competency framework at both basic and advanced levels. Among them, professional knowledge is the foundation, while professional quality motivates nurses to participate. In addition to competency assessment, it can also be used for training and human resource deployment based on seniority or professional level. This could bridge the knowledge gap and improve the engagement of nurses in heavy workload situations. RELEVANCE TO CLINICAL PRACTICE This practice scope will provide opportunities for nurses to engage in antimicrobial stewardship. Moreover, nursing competencies identified in this field could facilitate the development of competency-based education interventions, talent assessments, training and recruitment programs. DATA RESOURCES PubMed, EMBASE, Web of Science, CINHAL, PsycINFO, Cochrane Library, ProQuest and Scopus were searched from inception to November 2022, with an updated search in March 2023. IMPACT This scoping review provides evidence for best nursing practice scope and competency in antimicrobial stewardship in hospitals. However, it is also in line with the commitment of all nurses in the global community to combat antimicrobial resistance, which has become a global threat. An antimicrobial stewardship competency framework for bedside nurses was developed at both the basic and advanced levels. It would facilitate talent assessment, training, recruitment and human resource management by guiding the development of competency-based education interventions. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Wenting Zhao
- Nursing College, Shanxi Medical University, Taiyuan, China
- Department of Infection Management, The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Wei Guo
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Pei Sun
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Yuanhui Yang
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Yan Ning
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Ru Liu
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Yufei Xu
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Shuhua Li
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Linping Shang
- Department of Infection Management, The First Hospital of Shanxi Medical University, Taiyuan, China
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Bridey C, Le Dref G, Bocquier A, Bonnay S, Pulcini C, Thilly N. Nurses' perceptions of the potential evolution of their role in antibiotic stewardship in nursing homes: a French qualitative study. JAC Antimicrob Resist 2023; 5:dlad008. [PMID: 36743529 PMCID: PMC9891345 DOI: 10.1093/jacamr/dlad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
Background In nursing homes, infections and antibiotic prescriptions are frequent. Nursing home nurses (NHNs) and advanced practice registered nurses (APRNs) could promote antibiotic stewardship (ABS). Few studies have explored nurses' knowledge, perceptions and practices towards ABS in nursing homes and none has investigated the potential evolution of their roles. Objectives To explore French nurses' perceptions on ABS, current and future potential roles in ABS in nursing homes, as well as facilitators and barriers. Methods We conducted a qualitative study in north-eastern France between October 2020 and March 2021 using semi-structured individual interviews with NHNs and a focus group with APRNs. Transcripts of the interviews were analysed using a thematic analysis. Results Twenty NHNs and seven APRNs participated. They were aware of antibiotic misuse and potential adverse events but lacked knowledge on some ABS aspects. NHNs' current ABS roles ranged from the detection of clinical infectious signs to clinical monitoring of residents, with some heterogeneity between nurses. They had positive opinions towards playing a more prominent role in ABS. In the future, with additional training, changes in the legislative framework and greater multidisciplinary teamwork, NHNs thought they could prescribe laboratory microbiological analyses and some targeted antibiotic treatments. APRNs thought they could prescribe first-line antibiotics for urinary tract infections. Conclusions French NHNs' current ABS roles could be expanded and new roles might be considered while taking into account several facilitators and barriers. According to APRNs, they could help to compensate for the limited presence of doctors in nursing homes and develop infectious diseases skills.
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Affiliation(s)
| | | | | | | | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000 Nancy, France,Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, F-54000 Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France,Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, F-54000 Nancy, France
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Hendy A, Al-Sharkawi S, Hassanein SMA, Soliman SM. Effect of educational intervention on nurses' perception and practice of antimicrobial stewardship programs. Am J Infect Control 2023; 51:41-47. [PMID: 35561943 DOI: 10.1016/j.ajic.2022.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nurse involvement in antimicrobial stewardship programs is insufficient, which limits the programs' effectiveness. To evaluate the effect of the training programs on nurses' perception and practice of antimicrobial stewardship to embed it in practice. METHODS A quasi-experimental study without a control group was conducted on 115 nurses. A specifically validated and designed instrument was utilized to evaluate perception and practice before, after, and 2 months follow-up the training sessions. RESULTS The difference between the pre, post, and 2 months follow-up tests was highly significant for the dimensions of knowledge, perception, and practice (P < .01). Also, nurses reported a lack of knowledge, lack of training, high workload as barriers of AMS. Nurses suggested ways to overcome barriers such as physician and manager support, in-service training every 6 months, and saving time for training and education. CONCLUSIONS An educational intervention improved perception and practice among nurses related to antimicrobial stewardship and easily embedded it in practice.
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Affiliation(s)
- Abdelaziz Hendy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt.
| | - Sabah Al-Sharkawi
- Faculty of Nursing, October University, Pediatric Department, Faculty of Nursing, Ain Shams University, Egypt
| | | | - Sahar M Soliman
- Department of Maternal & Neonatal Health Nursing, Faculty of Nursing, Ain Shams University, Egypt
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Danielis M, Regano D, Castaldo A, Mongardi M, Buttiron Webber T. What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review. Antimicrob Resist Infect Control 2022; 11:153. [PMID: 36474301 PMCID: PMC9727984 DOI: 10.1186/s13756-022-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Matteo Danielis
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.5390.f0000 0001 2113 062XSchool of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Domenico Regano
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Castaldo
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,IRCCS Fondazione Don Gnocchi, Via Capecelatro, 66, 20148 Milano, Italy
| | - Maria Mongardi
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.5611.30000 0004 1763 1124Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, P. le L.A. Scuro 10, 37134 Verona, Italy
| | - Tania Buttiron Webber
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.450697.90000 0004 1757 8650Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
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Hall J, Hawkins O, Montgomery A, Singh S, Mullan J, Degeling C. Dismantling antibiotic infrastructures in residential aged care: The invisible work of antimicrobial stewardship (AMS). Soc Sci Med 2022; 305:115094. [PMID: 35690033 DOI: 10.1016/j.socscimed.2022.115094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
Recent social science scholarship has sought to understand the visible and invisible impacts of how antibiotics are entrenched as infrastructures and put to work as a proxy for higher levels of care (clinical or otherwise) within modern healthcare. Using a qualitative research design, in this paper our aim is to draw attention to less visible aspects of antimicrobial stewardship (AMS) in residential aged care and their implications for nurse-led optimization of antibiotic use in these settings. By developing an account of the perceptions, experiences and practices of staff regarding the 'on the ground' work associated with implementing and upholding AMS objectives our study extends research on attempts to dismantle antibiotic infrastructures in Australian residential aged care facilities (RACF). Drawing on a review of relevant policies, empirical data is presented from fifty-six in-depth interviews conducted in 2021 with staff at 8 different RACFs. Interview participants included managers, nurses, and senior and junior personal care assistants. Our results suggest that registered nurses in residential aged care have been tasked with promoting antibiotic optimization and assigned with AMS responsibilities without sufficient authority and resourcing. A host of hidden care work associated with AMS strategies was evident, reinforcing some staff support for empirical antibiotic prescribing as a 'safety net' in uncertain clinical cases. We argue that this hidden work occurs where AMS strategies displace the infrastructural role previously performed by antibiotics, exposing structural gaps and pressures. The inability of organisational accounting systems and the broader AMS policy agenda to capture hidden AMS workflows in RACFs has consequences for future resourcing and organisational learning in ways that mean AMS gaps may remain unaddressed. These results support findings that AMS interventions might not be easily accepted by aged care staff in view of associated burdens which are under recognised and under supported in this domain.
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Affiliation(s)
- Julie Hall
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Saniya Singh
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia; School of Psychology, University of Wollongong, NSW, Australia
| | - Judy Mullan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia; Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia.
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White KA, Barnes LE, Snyder RL, Fike LV, Kuhar DT, Cochran RL. Making a C-DIFFerence: Implementation of a prevention collaborative to reduce hospital-onset Clostridioides difficile infection rates. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e87. [PMID: 36483418 PMCID: PMC9726520 DOI: 10.1017/ash.2022.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To assist hospitals in reducing Clostridioides difficile infections (CDI), the Centers for Disease Control and Prevention (CDC) implemented a collaborative using the CDC CDI prevention strategies and the Targeted Assessment for Prevention (TAP) Strategy as foundational frameworks. SETTING Acute-care hospitals. METHODS We invited 400 hospitals with the highest cumulative attributable differences (CADs) to the 12-month collaborative, with monthly webinars, coaching calls, and deployment of the CDC CDI TAP facility assessments. Infection prevention barriers, gaps identified, and interventions implemented were qualitatively coded by categorizing them to respective CDI prevention strategies. Standardized infection ratios (SIRs) were reviewed to measure outcomes. RESULTS Overall, 76 hospitals participated, most often reporting CDI testing as their greatest barrier to achieving reduction (61%). In total, 5,673 TAP assessments were collected across 46 (61%) hospitals. Most hospitals (98%) identified at least 1 gap related to testing and at least 1 gap related to infrastructure to support prevention. Among 14 follow-up hospitals, 64% implemented interventions related to infrastructure to support prevention (eg, establishing champions, reviewing individual CDIs) and 86% implemented testing interventions (eg, 2-step testing, testing algorithms). The SIR decrease between the pre-collaborative and post-collaborative periods was significant among participants (16.7%; P < .001) but less than that among nonparticipants (25.1%; P < .001). CONCLUSIONS This article describes gaps identified and interventions implemented during a comprehensive CDI prevention collaborative in targeted hospitals, highlighting potential future areas of focus for CDI prevention efforts as well as reported challenges and barriers to prevention of one of the most common healthcare-associated infections affecting hospitals and patients nationwide.
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Affiliation(s)
- Katelyn A. White
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura E.A. Barnes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel L. Snyder
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucy V. Fike
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T. Kuhar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronda L. Cochran
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pallares C, Hernández-Gómez C, Appel TM, Escandón K, Reyes S, Salcedo S, Matta L, Martínez E, Cobo S, Mora L, Marín A, Correa A, De La Cadena E, Rodríguez-Baño J, Villegas MV. Impact of antimicrobial stewardship programs on antibiotic consumption and antimicrobial resistance in four Colombian healthcare institutions. BMC Infect Dis 2022; 22:420. [PMID: 35501756 PMCID: PMC9059380 DOI: 10.1186/s12879-022-07410-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) have become a fundamental pillar in optimizing antimicrobial usage, improving patient care, and reducing antimicrobial resistance (AMR). Herein we evaluated the impact of an ASP on antimicrobial consumption and AMR in Colombia. METHODS We designed a retrospective observational study and measured trends in antibiotic consumption and AMR before and after the implementation of an ASP using interrupted time series analysis over a 4-year period (24 months before and 24 months after ASP implementation). RESULTS ASPs were implemented according to the available resources in each of the institutions. Before ASP implementation, there was a trend toward an increase in the antibiotic consumption of all measured antimicrobials selected. Afterward, an overall decrease in antibiotic consumption was observed. The use of ertapenem and meropenem decreased in hospital wards, while a decrease in the use of ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, and vancomycin was observed in intensive care units. After ASP implementation, the trend toward an increase of oxacillin-resistant Staphylococcus aureus, ceftriaxone-resistant Escherichia coli, and meropenem-resistant Pseudomonas aeruginosa was reversed. CONCLUSIONS In our study, we showed that ASPs are a key strategy in tackling the emerging threat of AMR and have a positive impact on antibiotic consumption and resistance.
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Affiliation(s)
- Christian Pallares
- Grupo de Investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad el Bosque, Bogotá, Colombia. .,Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia. .,Clínica Imbanaco Grupo Quirónsalud Cali, Cali, Colombia.
| | - Cristhian Hernández-Gómez
- Grupo de Investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad el Bosque, Bogotá, Colombia.,Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Tobías Manuel Appel
- Grupo de Investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad el Bosque, Bogotá, Colombia
| | - Kevin Escandón
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sergio Reyes
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | | | - Lorena Matta
- Corporación Clínica Universitaria Comfenalco, Cali, Colombia
| | | | - Sara Cobo
- DIME Clínica Neurocardiovascular, Cali, Colombia
| | - Laura Mora
- Clínica General del Norte, Barranquilla, Colombia
| | | | - Adriana Correa
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,Universidad Santiago de Cali, Cali, Colombia
| | - Elsa De La Cadena
- Grupo de Investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad el Bosque, Bogotá, Colombia.,Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain.,Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - María Virginia Villegas
- Grupo de Investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad el Bosque, Bogotá, Colombia.,Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.,Clínica Imbanaco Grupo Quirónsalud Cali, Cali, Colombia
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Mohammed S, Gorski L. Antimicrobial Resistance and Antimicrobial Stewardship in Home Healthcare. Home Healthc Now 2021; 39:238-246. [PMID: 34473111 DOI: 10.1097/nhh.0000000000001012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Antimicrobial resistance, the ability of microbes to become resistant to known antimicrobial medications, is a growing and serious global health concern. There are growing numbers of publications about efforts to educate nurses about antimicrobial resistance, and efforts to involve nurses in antimicrobial stewardship in acute and long-term care settings; however, this has not been the case in home care. Home care organizations are required to address infection control and surveillance, including patient, family, and staff education. Home care nurses play an important role in identifying infections, performing cultures, and teaching patients and families. This article provides an overview of antimicrobial resistance and antimicrobial stewardship and provides antimicrobial stewardship actions for home care nurses and agencies. In the interest of public health, home care agencies and nurses can, and should, educate themselves and patients about antimicrobial resistance and employ antimicrobial stewardship strategies.
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Knobloch MJ, Musuuza J, Baubie K, Saban KL, Suda KJ, Safdar N. Nurse practitioners as antibiotic stewards: Examining prescribing patterns and perceptions. Am J Infect Control 2021; 49:1052-1057. [PMID: 33524451 DOI: 10.1016/j.ajic.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Advanced practice providers in the outpatient setting play a key role in antibiotic stewardship, yet little is known about how to engage these providers in stewardship activities and what factors influence their antibiotic prescribing practices. METHODS We used mixed methods to obtain data on practices and perceptions related to antibiotic prescribing by nurse practitioners (NP) and Veteran patients. We interviewed NPs working in the outpatient setting at one Veterans Affairs facility and conducted focus groups with Veterans. Emerging themes were mapped to the Systems Engineering Initiative for Patient Safety framework. We examined NP antibiotic prescribing data from 2017 to 2019. RESULTS We interviewed NPs and conducted Veteran focus groups. Nurse practitioners reported satisfaction with resources, including ready access to pharmacists and infectious disease specialists. Building patient trust was reported as essential to prescribing confidence level. Veterans indicated the need to better understand differences between viral and bacterial infections. NP prescribing patterns revealed a decline in antibiotics prescribed for upper respiratory illnesses over a 3-year period. CONCLUSION Outpatient NPs focus on educating the patient while balancing organizational access challenges. Further research is needed to determine how to include both NPs and patients when implementing outpatient antibiotic stewardship strategies. Further research is also needed to understand factors associated with the decline in nurse practitioner antibiotic prescribing observed in this study.
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15
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van Gulik N, Hutchinson A, Considine J, Driscoll A, Malathum K, Botti M. Perceived roles and barriers to nurses' engagement in antimicrobial stewardship: A Thai qualitative case study. Infect Dis Health 2021; 26:218-227. [PMID: 33994163 DOI: 10.1016/j.idh.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antimicrobial stewardship is the practice of ensuring the optimal use of antibiotics to prevent antimicrobial resistance. A multidisciplinary approach is considered best practice; however, little is known about nurses' contribution. OBJECTIVES To explore how organisational multidisciplinary leaders and clinical nurses perceive nurses' roles in AMS in a single organisational site case study based in Thailand, within the current governance, educational and practice context, and the barriers to nurses' engagement in AMS. METHODS A qualitative descriptive study using thematic analysis approach was conducted in a 1000-bed university hospital in Bangkok, Thailand. The combined number of organisational leaders and nurses was 33 including 15 individual organisational leader interviews and three focus groups involving 18 nurses. RESULTS Nurses currently participate in AMS by supporting system processes, monitoring safety and optimal antibiotic use and patient education. A lack of clear articulation of nurses' role and traditional professional hierarchies limits active participation. Inconsistent engagement was perceived as due to a failure to prioritise AMS activities, a lack of formal policies and a need for further education. CONCLUSION Nurses do engage in AMS but there are significant governance, hierarchical and educational impediments. These gaps need to be addressed before clearly defined nurse roles in AMS can be developed and embedded into clinical practice.
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Affiliation(s)
- Nantanit van Gulik
- Ramathibodi School of Nursing, Mahidol University, Bangkok 10400, Thailand; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, VIC 3121, Australia
| | - Julie Considine
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC 3128, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Austin Health, Heidelberg, VIC 3084, Australia
| | - Kumthorn Malathum
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Mari Botti
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, VIC 3121, Australia
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The Effect of an Educational Program on Nursing Knowledge and Empowerment in Antimicrobial Stewardship in a Surgical Intensive Care Unit. Dimens Crit Care Nurs 2021; 40:21-28. [PMID: 33560632 DOI: 10.1097/dcc.0000000000000450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hospital antimicrobial stewardship (AS) interventions have been shown to reduce the overuse and misuse of antimicrobials and rates of resistant organisms. To date, nurses have had limited involvement in AS. Improving nursing AS knowledge and sense of empowerment may improve their engagement in AS. OBJECTIVE The purpose of this study was to evaluate the impact of an educational intervention on AS knowledge and sense of empowerment among bedside registered nurses (RNs) in a surgical intensive care unit in an academic medical center. METHODS This was a quasi-experimental pre-post study. RESULTS Forty-four RNs (85%) participated. There was a statistically significant (P < .01) increase in both AS knowledge and empowerment level of staff RNs. Registered nurses identified participation in patient care rounds and use of antibiotic timeouts as strategies for increasing their AS engagement. Perceived barriers included lack of physician/other team member support and knowledge deficits. CONCLUSIONS The findings of this study indicate that educating nurses on their role in AS improves their knowledge and sense of empowerment for this emerging role. Future studies should examine how nurses apply this knowledge and sense of empowerment to engage in unit-based AS activities and the resultant patient outcomes.
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Padigos J, Reid S, Kirby E, Broom J. Knowledge, perceptions and experiences of nurses in antimicrobial optimization or stewardship in the intensive care unit. J Hosp Infect 2020; 109:10-28. [PMID: 33290817 DOI: 10.1016/j.jhin.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022]
Abstract
There is an urgent and recognized need for an interprofessional collaborative approach to support global action in addressing antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) refers to systematic approaches for antimicrobial optimization within healthcare organizations. In areas with high antimicrobial utilization such as intensive care units (ICUs), specific roles for nurses in AMS are not clearly defined. This review aimed to identify and to critically evaluate primary studies that examined knowledge, perspectives and experiences of nurses associated with antimicrobial use and optimization in ICUs. A systematic search of Medline, CINAHL, PsychINFO, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science databases for primary studies published from 1st January 2000 to 20th March 2020 was performed. A convergent synthesis design was used to synthesize quantitative and qualitative data. Of the 898 studies initially screened, 26 were included. Most (18/26) studies were quantitative. All qualitative studies (6/26) were of high methodological quality. Studies where interventions were used (10/26) identified significant potential for ICU nurses to reduce antimicrobial use, time-to-antibiotic administration, and error rates. Barriers to nursing engagement included knowledge deficits in antimicrobial use, interprofessional dissonance and the culture of deference to physicians. Enhancing education, technology utilization, strong nursing leadership and robust organizational structures that support nurses were perceived as enablers to strengthen their roles in optimizing antimicrobial use. This review showed that nursing initiatives have significant potential to strengthen antimicrobial optimization in ICUs. Barriers and enablers to active engagement were identified.
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Affiliation(s)
- J Padigos
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Queensland, 4551, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
| | - S Reid
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - E Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - J Broom
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland 4551, Australia
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18
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Mbugua SM, Njoroge G, Kijogi C, Kamita M, Kimani R, Mwaura P, Aidi BW, Gitaka J. Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya. Glob Health Res Policy 2020; 5:49. [PMID: 33292855 PMCID: PMC7670798 DOI: 10.1186/s41256-020-00177-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change. METHODS A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants. RESULTS Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment. CONCLUSIONS The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.
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Kirby E, Broom A, Overton K, Kenny K, Post JJ, Broom J. Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study. BMJ Open 2020; 10:e042321. [PMID: 33122328 PMCID: PMC7597488 DOI: 10.1136/bmjopen-2020-042321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This 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. DESIGN Qualitative 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. SETTING Four hospitals (three public and one private), across metropolitan, regional and remote areas, in two Australian states. PARTICIPANTS 86 nurses (77 females, 9 males), from a range of hospital departments, at a range of career stages. RESULTS Findings 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. CONCLUSION Nursing 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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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social and Political Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Overton
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Katherine Kenny
- School of Social and Political Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Jennifer Broom
- Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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20
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Gotterson F, Buising K, Manias E. Nurse role and contribution to antimicrobial stewardship: An integrative review. Int J Nurs Stud 2020; 117:103787. [PMID: 33647845 DOI: 10.1016/j.ijnurstu.2020.103787] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 01/22/2023]
Abstract
AIM To examine existing published literature regarding nurses and antimicrobial stewardship, and their potential role and contribution, to identify what is known, to evaluate methodologies used in published research, and to review and integrate findings to inform practice and future priorities for research. DESIGN Integrative review. METHODOLOGY The approach to this review was informed by Whittemore and Knafl's integrative review methodology. Electronic databases were searched for papers published since the start of the database to November 2019, with abstracts available, related to humans and published in English. Papers were included regardless of practice setting (acute, aged, and primary care) and if they were research based, included nurses as participants and reported specifically on results from nurses or that had implications for nursing practice. Excluded were conference abstracts, and papers focussed solely on nurse prescriber, nurse practitioner, or nurse manager roles. RESULTS Fifty-two papers were included in the review. Identified themes were: i) nursing knowledge, learning needs and education; ii) nurse perceptions of the nursing role and motivations for involvement; iii) nursing brokerage and influence on information flow to and from patients; iv) nursing workflow, workload and workarounds; and v) nurse leadership. Methodological quality of the included papers varied, limiting transferability and applicability of findings for some of the included studies. CONCLUSION Formal inclusion of nurses in antimicrobial stewardship activities has been associated with improved nurse knowledge, nurse confidence, and in some cases improved clinical outcomes for patients. The review reinforces nursing values as a motivator of nursing actions, and reveals the complex yet significant influence of nurses on antimicrobial prescribing. Potential opportunities to enhance nurses' participation and contribution to antimicrobial stewardship include; formal acknowledgement of the nurse role, educating nurses so that they are aware of how they can contribute, collaborating with nurses in planning and implementing local stewardship activities, and ensuring nurse leaders are involved. However, evidence on this topic remains limited. Research is needed to facilitate greater understanding about the nature, scope and influence of the nurse role in antimicrobial stewardship, how nurses enact and carry out their role, and nurses' support needs. Tweetable abstract: Integrative review explores #nurse role in #antimicrobialstewardship. Nurse contribution, influence significant, but not well understood.
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Affiliation(s)
- Fiona Gotterson
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, VIC 3010, Australia.
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, VIC 3010, Australia; Victorian Infectious Diseases Service, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC 3125, Australia; The Royal Melbourne Hospital, Department of Medicine, Royal Parade, Parkville, VIC 3052, Australia
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van Huizen P, Kuhn L, Russo PL, Connell CJ. The nurses' role in antimicrobial stewardship: A scoping review. Int J Nurs Stud 2020; 113:103772. [PMID: 33080476 DOI: 10.1016/j.ijnurstu.2020.103772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of nurses in antimicrobial stewardship is understated and not well understood. Nurses can have a significant impact on the development of antimicrobial resistant bacteria in hospitals and the wider community through their management of intravenous antibiotics. OBJECTIVE To investigate the nurse's role in antimicrobial stewardship and examine best practice for preparing, administering and disposing of intravenous antibiotics. METHODS A systematically conducted scoping review was used. Seven databases were searched for published articles. Retrieved articles were screened for eligibility against pre-set inclusion and exclusion criteria with eligible full-text articles included in the synthesis. Reference lists of eligible articles and social media were reviewed to identify further sources of literature. RESULTS Forty-three sources of evidence were included. The extracted data indicate that a part of the nurse's role in antimicrobial stewardship is to monitor judicious antibiotic prescribing practices. Other than literature related to medication errors, there was limited research describing best practice when preparing, administering and disposing of intravenous antibiotics. There was also little evidence of consistent policy, guidelines and education for nurses' practice related to antimicrobial stewardship. CONCLUSIONS The evidence for best practice when nurses prepare, administer and dispose of intravenous antibiotics in hospitals is scarce. When nurses use best practice to manage intravenous antibiotics, the risk of antimicrobial resistant bacteria developing is minimised. The role of nurses in antimicrobial stewardship needs to be supported through education and evidence-based guidelines. Tweetable abstract: Nurse work practices may prevent the development and spread of antimicrobial resistant bacteria.
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Affiliation(s)
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Australia.
| | - Philip L Russo
- School of Nursing and Midwifery, Monash University, Australia; Nursing Research, Cabrini Health, Australia.
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Han M, Zhang X. Impact of medical professionals on Carbapenem-resistant Pseudomonas aeruginosa: moderating effect of workload based on the panel data in China. BMC Health Serv Res 2020; 20:670. [PMID: 32690017 PMCID: PMC7372746 DOI: 10.1186/s12913-020-05535-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
Background Antimicrobial resistance (AMR), especially carbapenem-resistant Pseudomonas aeruginosa (CRPA), causes a serious increase in morbidity, mortality and costs. Medical professionals play an important role in curbing AMR. Previous studies overlooked the impact of workload on the relationship between medical professionals and AMR. This study aimed to explore the relationship between medical professionals and the CRPA rate as well as the moderating effect of medical professionals’ workload on this relationship. Methods A provincial-level panel dataset from 2014 to 2017 was constructed. Medical professionals were measured by the numbers of physicians, registered nurses, pharmacists, and clinical microbiologists per 1000 population. Workload was measured by the number of daily physician visits. Fixed effect model and hierarchical regression analysis were performed to explore the moderating effect of workload on medical professionals and the CRPA rate. Results The numbers of physicians, registered nurses, pharmacists and clinical technicians were significantly negative associated with the CRPA rate (coef. = − 0.889, − 0.775, − 1.176, and − 0.822; P = 0.003, 0.003, 0.011, and 0.007, respectively). Workload had a significant and positive moderating effect on physicians, registered nurses, pharmacists, clinical technicians and the CRPA rate (coef. = 1.270, 1.400, 2.210, and 1.634; P = 0.004, 0.001, 0.035, and 0.003, respectively). Conclusions Increasing the number of medical professionals may help curb the CRPA rate. Measures aimed at reducing medical professionals’ workload should be implemented to further improve CRPA performance.
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Affiliation(s)
- Meng Han
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei Province, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei Province, China.
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Macduff C. Fostering nursing innovation to prevent and control antimicrobial resistance using approaches from the arts and humanities. J Res Nurs 2020; 25:189-207. [PMID: 34394626 PMCID: PMC7932494 DOI: 10.1177/1744987120914718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Efforts to address the complex global problem of antimicrobial resistance (AMR) highlight the need for imagination and innovation. However, nursing has not yet leveraged its potential to innovate to prevent AMR advancing. AIMS This paper focuses on the initial phase of an ongoing research and development study that seeks to foster nursing imagination and innovation by enhancing the meaningfulness of AMR for practising nurses and by facilitating their creative ideas. METHODS This aim is addressed through application of arts and humanities approaches, in particular the use of visualisation, co-design and historical methods, underpinned by the Design Council Double Diamond process model. The first phase with 20 UK participants explored how hospital and community-based nurses understand and respond to the priorities and consequences of AMR within their everyday working lives. RESULTS Nurses varied in their conceptualisations of AMR and in their depictions and explanations of its meaning and priority within everyday practices. Some saw infection prevention and control as bound up with AMR, whereas others differentiated in the context of specific work activities. Insights into related reasoning and practice tactics were also generated. CONCLUSIONS The initial project phase provides a basis for fostering nursing innovation in this important field.
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Affiliation(s)
- Colin Macduff
- Senior Research Fellow, School of Design, Glasgow School of Art, UK
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Monsees E, Goldman J, Vogelsmeier A, Popejoy L. Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals. Am J Infect Control 2020; 48:239-245. [PMID: 31926758 DOI: 10.1016/j.ajic.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are national calls to engage nurses as antimicrobial stewards, but it is unknown how patient safety culture influences nurses' antimicrobial stewardship (AS) involvement. METHODS Cross-sectional survey to determine bedside nurses' recognition and performance confidence in AS. Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas. Composite scores for nursing practices, performance confidence, and organizational factors were developed and correlated. Analysis of variance (ANOVA) with Tukey HSD post-hoc tests and nonparametric (Kruskal-Wallis) tests with Bonferroni adjusted P values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Free text comments were categorized by theme. RESULTS A total of 558 nurses participated (13% response rate). A significant positive association rs = 0.454, P < .001 was found between nurses' beliefs about nursing practices that contribute to AS processes and their confidence to perform. Ninety one nurses provided comments with 50 statements indicating the primary barrier to stewardship were organizational factors including perceived lack of a safety culture. CONCLUSIONS Nurses identified a professional role in AS processes, though safety culture inhibited their involvement. These findings can help enhance the inclusion of nurses in AS efforts.
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Affiliation(s)
- Elizabeth Monsees
- Division of Infectious Diseases, Children's Mercy Hospital, Patient Care Services Research, Kansas City, MO.
| | - Jennifer Goldman
- Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, MO
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO
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Raybardhan S, Kan T, Chung B, Ferreira D, Bitton M, Shin P, Das P. Nurse Prompting for Prescriber-Led Review of Antimicrobial Use in the Critical Care Unit. Am J Crit Care 2020; 29:71-76. [PMID: 31968088 DOI: 10.4037/ajcc2020272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Developing a sustainable strategy for prescriber-led review of antimicrobial use in a critical care unit may improve antimicrobial use without the need for additional resources. METHODS Using a quality improvement framework, the researchers created a prompt for prescriber-led review of antimicrobial use. The outcome measure was antimicrobial use (days of therapy per 1000 patient days). The process measure was the proportion of relevant cases for which an antimicrobial prompt was provided. Balancing measures included mortality rate, length of stay, 48-hour readmission rates, and multiple organ dysfunction score. Interrupted time series with segmented regression analysis was used for the outcome measure. RESULTS Process analysis identified critical care unit nurses for antimicrobial use prompting. A standard script was developed to incorporate a days of therapy prompt into nurse rounds, with primed prescriber responses. Before the intervention, monthly antimicrobial use was 804 days of therapy per 1000 patient days, with a positive trend (7.3 days of therapy per 1000 patient days, P < .05). After the intervention, there was an immediate reduction of 217 days of therapy per 1000 patient days (P < .05), with a nonsignificant negative trend, representing a 20% (95% CI, -15% to -25%) reduction. No significant change was noted in use of the control class of medications. The proportion of relevant cases for which an antimicrobial prompt was provided increased from 21% to 48% during the intervention period. Balancing measures were comparable before and after the intervention. CONCLUSIONS Nurse prompting can lead to significant reductions in antimicrobial use, providing a sustainable mechanism for independent antimicrobial reassessment.
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Affiliation(s)
| | - Tiffany Kan
- Tiffany Kan is an antimicrobial stewardship pharmacist
| | - Bonnie Chung
- Bonnie Chung is a critical care unit (CCU) pharmacist
| | | | | | - Phil Shin
- Phil Shin is chief of medicine/critical care, and
| | - Pavani Das
- Pavani Das is division chief of infectious diseases, North York General Hospital, Toronto, Ontario, Canada
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Antimicrobial stewardship: Staff nurse knowledge and attitudes. Am J Infect Control 2019; 47:1219-1224. [PMID: 31128981 DOI: 10.1016/j.ajic.2019.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Registered nurses are uniquely qualified to augment antimicrobial stewardship (AS) processes. However, the role of nursing in AS needs further development. More information is needed regarding gaps in registered nurse knowledge, attitudes toward AS, and how infection preventionists can help. METHODS An online descriptive survey was deployed to a convenience sample of approximately 2,000 nurses at the bedside. The survey included 15 questions addressing: (1) overall knowledge of AS; (2) antimicrobial delivery; (3) knowledge and attitudes regarding antimicrobial use; (4) antimicrobial resistance; and (5) antimicrobial resources and education. RESULTS Three hundred sixteen staff nurses from 3 hospitals (15.8%) responded to the survey. Fifty-two percent of nurses were not familiar with the term "antimicrobial stewardship," although 39.6% of nurses indicated that an AS program was moderately or extremely important in their health care setting. Almost all nurses (95%) believed that they should be involved in AS interventions. DISCUSSION These findings suggest gaps in nursing knowledge rearding AS. However, nurses believed AS programs were important and were eager to be involved. CONCLUSIONS This study showed that many nurses are not aware of AS, or do not understand their role in contributing to AS endeavors. Infection preventionist education should focus on increasing staff nurse awareness and demonstrating how nurses can make specific AS interventions.
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A Multidisciplinary Approach to Incorporate Bedside Nurses into Antimicrobial Stewardship and Infection Prevention. Jt Comm J Qual Patient Saf 2019; 45:600-605. [PMID: 31029590 DOI: 10.1016/j.jcjq.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 03/09/2019] [Accepted: 03/21/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Antimicrobial stewardship programs exist to promote appropriate antimicrobial use. The Joint Commission has reported that although many US hospitals have implemented basic components of antimicrobial stewardship programs, there now exists a need for innovative, multidisciplinary approaches, including involving frontline clinicians such as bedside nurses. METHODS A retrospective evaluation of bedside nurse-driven antimicrobial stewardship and infection prevention rounds was conducted on a 31-bed telemetry unit of a community regional medical center. Rounds were managed by a nurse coordinator and attended by an infectious diseases pharmacist, an infection preventionist, and a nurse practitioner. Primary outcome measures were antimicrobial and acid suppressant medication and invasive catheter use. RESULTS In the 12-month intervention period the nurse-driven rounds team reviewed of a total of 472 antimicrobial medication, 480 acid suppressant medication, 321 urinary catheter, and 61 central venous catheter therapies over 867 total patient encounters. Compared with the 12-month preintervention period, significant reductions in unit antimicrobial use (791.2 vs. 697.1 days of therapy per 1,000 patient-days; p = 0.03), acid suppressant medication use (708.1 vs. 372.4 days of therapy per 1,000 patient-days; p = 0.0001), and urinary catheter use (0.3 vs. 0.2 catheter-days per patient-day; p = 0.002) were observed. CONCLUSION This study demonstrates successful engagement of bedside nurses in antimicrobial stewardship and infection prevention activities and a measurable impact on meaningful outcomes. More studies of strategies to integrate bedside nurses in antimicrobial stewardship are needed.
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Abbas S, Lee K, Pakyz A, Markley D, Cooper K, Vanhoozer G, Doll M, Bearman G, Stevens MP. Knowledge, attitudes, and practices of bedside nursing staff regarding antibiotic stewardship: A cross-sectional study. Am J Infect Control 2019; 47:230-233. [PMID: 30471970 DOI: 10.1016/j.ajic.2018.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nursing engagement in antibiotic stewardship programs (ASPs) remains suboptimal. The purpose of this study was to determine the knowledge, attitudes, and practices of nursing staff members regarding ASPs and identify barriers to their participation in such programs. METHODS This cross-sectional study was conducted at Virginia Commonwealth University Health System, an 860-bed tertiary care academic center located in Richmond, Virginia, where a well-resourced ASP has been in place for 2 decades. A survey consisting of 12 questions was administered to nursing staff via REDCap (Research Electronic Data Capture) in February 2018. RESULTS A total of 159 survey responses were included in the study. The results demonstrated gaps in knowledge regarding antibiotic stewardship (AS) and highlighted the importance of improving communication between nurses and ASPs. Overall, 102 (64.15%) of the study participants indicated familiarity with AS. Time constraints and concerns over physician pushback were identified as major barriers to participation. CONCLUSIONS Many nurses were unaware of our center's ASP. Nurses identified activities falling within their daily workflow as potential areas for contribution to ASPs. Key barriers to participation were also identified. These data will inform efforts to engage nursing in AS activities at our medical center.
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Affiliation(s)
- Salma Abbas
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA
| | - Kimberly Lee
- Department of Pharmacology, Virginia Commonwealth University, Richmond, VA
| | - Amy Pakyz
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA
| | - Daniel Markley
- Department of Internal Medicine, Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Kaila Cooper
- Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University, North Hospital, Richmond, VA
| | - Ginger Vanhoozer
- Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University, North Hospital, Richmond, VA
| | - Michelle Doll
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA; Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University, North Hospital, Richmond, VA
| | - Gonzalo Bearman
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA; Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University, North Hospital, Richmond, VA
| | - Michael P Stevens
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA.
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Integrating bedside nurses into antibiotic stewardship: A practical approach. Infect Control Hosp Epidemiol 2019; 40:579-584. [PMID: 30786944 DOI: 10.1017/ice.2018.362] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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.
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Fisher CC, Cox VC, Gorman SK, Lesko N, Holdsworth K, Delaney N, McKenna C. A theory-informed assessment of the barriers and facilitators to nurse-driven antimicrobial stewardship. Am J Infect Control 2018; 46:1365-1369. [PMID: 30077436 DOI: 10.1016/j.ajic.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Nurses represent an underused workforce for performing antimicrobial stewardship (AMS) activities. Before engaging nurses in these activities, barriers and facilitators to the targeted behavior change should be identified using a validated model. METHODS This was a prospective, qualitative, descriptive study to determine the barriers and facilitators to the promotion of intravenous (IV) to oral (PO) antimicrobials by nurses. Semi-structured 1-on-1 interviews of nurses were conducted from January-February 2017. Interviews were analyzed for themes within the domains of the theoretical domains framework (TDF) by directed-content analysis. RESULTS Evaluation of the 14 TDF domains revealed 9 modifiable barriers to nurse promotion of IV to PO step-down, including insufficient knowledge, lack of prescriber cooperation, lack of self-confidence, and low priority activity. Nine facilitators that could enhance nurse promotion of step-down were identified, including capability to assess patients for step-down, ability to communicate assessment results to the team, and preexistence of a variety of resources available for nurse education and training. Nurses perceived that increased step-down rates would increase nursing efficiency. CONCLUSIONS Nurses have the potential to improve AMS through promotion of IV to PO step-down of antimicrobials. Themes pertaining to barriers and facilitators of nurses' participation in IV to PO step-down of antimicrobials were identified.
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Abstract
The ability to treat infectious diseases with antimicrobials is an essential component of medical management. Antimicrobial therapy is based on the characteristics of the patient, drug, microorganisms causing the infection, and colonizing flora. Prudent antibiotic use is the only option to delay the emergence of resistance. Training in infectious diseases and knowledge of the principles of responsible antibiotic prescribing and uses must be improved. To change practice, health care professionals should be educated at all levels of their training.
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Affiliation(s)
- Inge C Gyssens
- Department of Medicine, Radboud University Medical Center, AIG 463, PO Box 9101, Nijmegen 6500 HB, The Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Martelarenlaan 42, BE 3500, Hasselt, Belgium.
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Liu J, Yin C, Liu C, Tang Y, Zhang X. Modeling a Production Function to Evaluate the Effect of Medical Staffing on Antimicrobial Stewardship Performance in China, 2009-2016: Static and Dynamic Panel Data Analyses. Front Pharmacol 2018; 9:775. [PMID: 30072897 PMCID: PMC6060732 DOI: 10.3389/fphar.2018.00775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Antimicrobial resistance (AMR) is an international problem. Emergence and spread of AMR are strongly associated with overuse or inappropriate use of antimicrobials. Antimicrobial stewardship ensures the appropriate use of antimicrobials, and is an effective approach to control AMR. This study aims to understand the relationship between medical staffing and antimicrobial stewardship performance in China. Methods: A provincial-level panel dataset from 2009 to 2016 is used. A macro production function is used to quantify the relationship. The output, antimicrobial stewardship performance, is measured by changes in methicillin resistance rates of Staphylococcus. aureus (S. aureus) and coagulase-negative staphylococci (CoNS). The labor input is measured by the numbers of infectious diseases physicians, pharmacists, clinical microbiologists, and nurses in hospitals per 100,000 populations, whereas the capital input is represented by the number of hospital beds per 100,000 populations. The technology is captured by the time index. Both static and dynamic panel data approaches are employed. Results: The increasing number of clinical microbiologists is a significant predictor of lower resistance of CoNS according to dynamic models (Coef. = -0.191, -0.351; p = 0.070, 0.004, respectively). However, a larger number of nurses is significantly associated with higher resistance of S. aureus (Coef. = 0.648; p = 0.044). In addition, the numbers of the other two groups of medical professionals exhibit no significant associations with stewardship performance. Conclusions: The study demonstrates the crucial role of clinical microbiologists in antimicrobial stewardship. The predicted increased risk of resistance with the higher number of nurses may be attributable to their lack of related knowledge and their unrecognized functions in antimicrobial stewardship.
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Affiliation(s)
- Junjie Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chun Yin
- The Center for Modern Chinese City Studies & School of Urban and Regional Science, East China Normal University, Shanghai, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Monsees E, Popejoy L, Jackson MA, Lee B, Goldman J. Integrating staff nurses in antibiotic stewardship: Opportunities and barriers. Am J Infect Control 2018; 46:737-742. [PMID: 29729830 DOI: 10.1016/j.ajic.2018.03.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Nursing has been called for greater participation in antibiotic stewardship. Although many of the functions that are integral to successful stewardship are within the scope of bedside nurses, data evaluating nursing engagement in stewardship are limited. The objective of this study was to identify nurses' roles and confidence in engaging in stewardship practices by conducting a survey of pediatric staff nurses employed at a 354-bed freestanding children's hospital with a well-established prospective audit and feedback stewardship program. METHODS An investigator-developed online survey was used to assess 10 identified practices that fall within the responsibility of inpatient nurses and contribute to the stewardship process. RESULTS One hundred and eighty nurses participated in the study. Nurses were highly confident assessing for an adverse drug reaction history, obtaining cultures prior to antibiotics, and participating in patient education. They were less confident in reviewing microbiology results to determine antibiotic appropriateness. Clinical practice and hospital culture influenced perceptions of the nursing role in stewardship. Reported barriers to stewarding included nurses not included in rounds, interdisciplinary power differentials, and nursing input not actively sought. CONCLUSIONS Barriers to nurse engagement were identified and could be addressed by improving education in microbiology and principles of antibiotic use along with more consistent inclusion of nurses in bedside rounds while also cultivating an environment where nurse contribution is actively sought.
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Manning ML, Pogorzelska-Maziarz M. Health care system leaders' perspectives on infection preventionist and registered nurse engagement in antibiotic stewardship. Am J Infect Control 2018; 46:498-502. [PMID: 29706152 DOI: 10.1016/j.ajic.2017.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Infection preventionists (IPs) and registered nurses (RNs) have an important role to play in antibiotic stewardship programs (ASPs). Recent articles highlight their potential roles in practice, research, education, and policy; however, little is known about their actual ASP engagement. Leaders often have early knowledge of emerging trends and evolving health care worker roles. METHODS A survey was developed using the Centers for Disease Control and Prevention's Core Elements of Hospital Antibiotic Stewardship Programs to assess health care system infection prevention and control leaders' perceptions of IP and RN engagement in hospital ASPs. RESULTS Thirty-five leaders representing all regions of the United States completed the survey. Their organizations tended to have significant ASP leadership support, but lacked ASP policies indicating IP and RN roles and responsibilities. IPs were more likely than RNs to be members of the ASP team and have greater ASP knowledge. Neither discipline was conducting patient education related to proper use of antibiotics, but this was identified as a future ASP role. The 2017 Joint Commission Antimicrobial Stewardship Standard was accelerating ASP implementation. CONCLUSIONS IPs and RNs are well-positioned to assume greater roles in ASPs, especially in educating patients about the safe and proper use of antibiotics. However, their roles must be clearly identified, defined, and quantified. In so doing, knowledge and skill gaps can be identified and specific educational programs developed to advance their successful engagement in ASPs.
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Affiliation(s)
- Mary Lou Manning
- Thomas Jefferson University, College of Nursing, Philadelphia, PA.
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