Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship

BACKGROUND

Antibiotic stewardship (ABS) is a set of strategies to optimize antimicrobial use while reducing antibiotic resistance, improving patient outcomes, and decreasing unnecessary costs. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts.

PURPOSE

The purpose of this study was to describe the knowledge, attitudes, and perceptions of NPs toward ABS.

METHODS

A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey. Descriptive statistics were used to assess normality.

RESULTS

A total of 194 NPs completed the questionnaire (88% female; 70% master's degree). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). Nurse practitioners based their antibiotic decisions on the antibiogram (63%) in their setting, whereas 56% indicated they start with broad spectrum and tailor antibiotic choices after cultures are received. Nurse practitioners understood that inappropriate antibiotic use causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important (94%) and felt confident in using antibiotics (86%). However, 94% agreed that antibiotics are overused nationally, and only 62% thought antibiotics were overused in their setting.

IMPLICATIONS FOR PRACTICE

Nurse practitioners recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.

2086. Antimicrobial Stewardship: Why Do Not Nurses Question the White Coat?

Background

Resistance to antimicrobials has become a global issue. To combat this, registered nurses (RNs) need to be active participants with prescribers in an interdisciplinary approach to antimicrobial stewardship (AS). The prescriber role in AS has been well developed; however, more is needed to understand how RNs can contribute to AS efforts. The purpose of this study was to describe nurses comfort level with questioning providers about antimicrobials.

Methods

A survey was sent to point of care RNs in a healthcare system (approx. 4000). A total of 600 useable responses were received (Response rate = 15%). The survey included 4-items about antimicrobial delivery. (1) What percent of the time do you know why the patient is receiving an antimicrobial? (2) Would you feel comfortable raising concerns about antimicrobials to the treatment team? (3) In the last 30 days have you questioned the antimicrobial choice, dose, route or duration? (4) Have you ever given an antimicrobial you thought was inappropriate? Data were analyzed using descriptive statistics. Differences by demographics (age, gender, ethnicity, education level and location) were assessed using χ ² statistics.

Results

Nurses reported that 84% of the time they knew “why” an antimicrobial was given. There was no difference by demographics. Over 80% of nurses also reported they felt comfortable raising concerns about antimicrobials. Nurses working in smaller hospitals reported being more comfortable raising concerns than nurses working in larger hospitals (P = 0.023). In the past 30 days, 19% of RNs questioned choice, 13% dose, 16% route, and 27% duration of antimicrobials. Nurses with Baccalaureate degree or higher were more likely to question antimicrobial dose (P = .023). However, 27% of RNs reported they had given an antimicrobial they thought was inappropriate. More RNs working in rural hospitals reported giving antimicrobials they thought were inappropriate compared with those working in larger hospitals (P = .013).

Conclusion

Providers as well as RNs need to collaborate to improve AS. Nurses in this study were not always comfortable raising concerns and administered antimicrobials they viewed as inappropriate. Providers may want to take steps to encourage collaboration with RNs about AS.

Disclosures

All authors: No reported disclosures.