Characteristics of nurse practitioner curricula in the United States related to antimicrobial prescribing and resistance

One size does not fit all: advanced practice provider considerations for the antimicrobial steward

Advanced practice providers are a diverse and established group of antimicrobial prescribers in both ambulatory and inpatient settings. We outline important considerations for antimicrobial stewardship programs and stewards to consider when engaging this important group of providers.

Nurses’ knowledge regarding children antibiotic use and resistance in Jordan: A cross-sectional study

<b>Purpose: </b>This study aimed at examining nurses’ knowledge, attitudes, and practices related to antibiotics use and resistance. A second objective was to identify Jordanian nurses’ sources of information about antibiotics.<br /> <b>Method: </b>A cross-sectional design was used for this study. Nurses (n=594) completed an online survey using Google Forms. Google Forms web link was distributed on Facebook, LinkedIn, Twitter, and other social media applications. The study included Jordanian nurses who worked in hospitals<b> </b>and healthcare institutions. the European Center for Diseases Control and Prevention survey was used that took about 15 minutes to complete.<br /> <b>Results: </b>According to the study, 48.2% of nurses prescribed antibiotics to patients daily or multiple times per day in the previous week; 13.3% of nurses offered support for daily or more frequent antibacterial drug use or infection control; and 42.3% of nurses mentioned they did not give antibiotics advice because they did not have a leaflet about their use and because the patients did not receive one.<br /> <b>Conclusion: </b>The study found that<b> </b>the most reported source for antibiotics information was Facebook and Instagram. Nurses need further education on proper use of antibiotics. Antimicrobial stewardship can benefit from the study findings, which can help develop interventions to improve antibiotics proper use.

A Seat at the Table: Delivering Effective Infectious Diseases and Antimicrobial Stewardship Education to Advanced Practice Providers at an Academic Medical Center

INTRODUCTION

Antimicrobial Stewardship programs promote appropriate antimicrobial use through different avenues, including education. Advanced Practice Providers (APPs) provide inpatient care in a wide-range of settings. Little is known about the educational needs of APPs at academic medical centers or the effect of educational interventions directed at inpatient APPs on clinical care. Our study looked at the effect of an educational intervention on antimicrobial prescribing by APPs for asymptomatic bacteriuria (ASB) and candiduria (ASC). We also conducted a needs assessment on the opportunities and barriers to continuing medical education.

METHODS

The educational intervention consisted of in-person interactive learning accompanied by an online video. Pre-intervention and postintervention surveys included an educational needs assessment and knowledge acquisition assessment. A retrospective chart review of adult inpatients admitted to the APP services with bacteriuria or candiduria during the 3 months pre-intervention and postintervention was performed.

RESULTS

Our needs assessment revealed several barriers to APP-focused education including no protected time for learning, and curricula predominantly directed at the Graduate Medical Education level. Engaged APPs had improved knowledge scores, but the proportion of treated ASB or ASC episodes did not differ between the pre-intervention and postintervention.

DISCUSSION

Although our educational intervention did not change prescribing patterns, the intervention increased knowledge around ASB and ASC. The potential hierarchical structure of interprofessional care teams may be a barrier to changing antimicrobial prescribing. Our study identified the possibility of a hidden curriculum at academic medical centers that does not prioritize APP educational needs.

Nurses and Antimicrobial Stewardship: Past, Present, and Future

Successful antimicrobial stewardship programs must be a truly collaborative multidisciplinary team effort. Nurses have critical contributions and are recognized more in publications about antimicrobial stewardship. Examination of patient care workflow patterns indicates the central role of nurses in the application of stewardship concepts in patient care. Education about antimicrobial resistance and antimicrobial stewardship is important not only for nurses and other health care providers but also for the general public. Analysis of the health care workforce population shows the importance of integrating this largest segment of health care providers in the routine daily care of patients into all stewardship efforts.

Integrating staff nurses in antibiotic stewardship: Opportunities and barriers

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.

Staff nurses as antimicrobial stewards: An integrative literature review

BACKGROUND

Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored.

METHODS

An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis.

RESULTS

Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management.

DISCUSSION

Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce.

CONCLUSIONS

Further exploration on the integration and measurement of nursing participation is needed to accelerate this important patient safety initiative.

Resisting resistance: practical decision tools for choosing antimicrobials safely

PURPOSE

The purpose of this article is to provide, in a concise format, information about evidence-based decision-making strategies and support tools available for appropriate antimicrobial prescribing. A brief review of the current status of antimicrobial resistance, prescribing practices of nurse practitioners (NPs), and factors associated with inappropriate prescribing practices is included to further explicate the need for such support tools.

DATA SOURCES

Journal articles, Internet websites, reference texts.

CONCLUSIONS

Many microorganisms have developed resistance to previously standard treatments, and resistant strains continue to emerge. One factor associated with increasing resistance is inappropriate or overprescribing of antimicrobials sometimes related to lack of easy accessibility to clinical decision-making tools. Some practical evidence-based tools and decision-making strategies are presented here to foster making optimal antimicrobial choices in clinical practice.

IMPLICATIONS FOR PRACTICE

Evidence-based decision-making strategies and tools can be used at the point of care to maximize appropriate antimicrobial prescribing by NPs.

A game for teaching antimicrobial mechanisms of action

BACKGROUND

Alternative teaching tools have proved to enhance students' interest and knowledge skills.

AIM

To integrate basic Bacteriology with mechanisms of action of antimicrobial agents.

METHODS

The board has 121 squares, including squares with question marks and antimicrobial agents. Each student receives a card with a clinical case, identification of the bacterium and its resistance to antimicrobials. The student rolls a dice and moves the corresponding number of squares. The game depends on the dice values rolled, the bacterial resistance profile, and the questions the student has to answer each time he/she lands on a question mark. Previously, the students were given a lecture about the subject. On the day of the game, students answered a pre-test and a post-test. The paired t-test was used for the statistical analysis.

RESULTS

The game was applied to 78 students of the Medicine and Pharmacy undergraduate courses of the Universidade Federal do Rio Grande do Sul, Brazil. There was an increase in the number of right answers and a decrease in the number of unknown answers. There were no significant differences between the courses.

CONCLUSION

The game could be applied to other undergraduate courses in the field of Health Sciences.

The Impact of Personalized Prenotification on Response Rates to an Electronic Survey

The purpose of this post-hoc investigation was to determine the difference in response rates between respondents who received personalized prenotification prior to receiving an electronic survey and those who did not. An electronic survey was e-mailed to 236 program directors or other designated individuals from nurse practitioner (NP) programs around the United States. Seventy six percent of the NP program directors were personally contacted about the survey in advance, and 97.5% agreed to participate. The remaining 24% were sent e-mails with a link to the survey without prenotification. Response rates for those in the prenotification group who had agreed to participate versus those who did not receive prenotification were 49% and 45%, respectively. Personalized prenotification did not affect the electronic survey response rates. Electronic research methodology offers a unique opportunity to potentially survey an entire population (e.g., nursing faculty), thus further investigation regarding factors associated with electronic survey response rates and ways to improve these rates is warranted.