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Assessing knowledge of antimicrobial stewardship
Abstract
The Scottish Antimicrobial Prescribing Group (SAPG) is a national clinical multidisciplinary forum that coordinates and delivers antimicrobial stewardship (AS). This work includes ensuring health professionals have the necessary knowledge to contribute to improving the use of antimicrobials and to develop and implement education resources if required. The SAPG undertook a survey to scope the current understanding and learning needs among nurses and midwives in a range of care settings across Scotland. This article reports on the results, which have been used to help develop a dedicated AS education programme for this group of health professionals.
... In all, 52 papers have been included in the review ( Fig. 1 ) Timeframe of publication for the 52 included studies ranged from 2008 to 2019. Of the included papers, 31 were quantitative; comprising 15 cross sectional studies ( Abbas et al., 2019 ;Abera et al., 2014 ;Cotta et al., 2014 ;Drekonja et al., 2019 ;Fehily et al., 2015 ;Greendyke et al., 2018 ;McGregor et al., 2015 ;Merrill et al., 2019 ;Monsees et al., 2018 ;Mostaghim et al., 2017 ;Scales et al., 2017 ;Sutthiruk et al., 2018 ;Toska and Geitona, 2015 ;Wilcock et al., 2019 ;Wilcock et al., 2018 ), 4 pre-post studies, ( Hale et al., 2017 ;Heath et al., 2016 ;Wentzel et al., 2016 ;Wilson et al., 2017 ) 4 quasi experimental studies, ( Gillespie et al., 2013 ;Shah et al., 2019 ;Stuart et al., 2015 ;Zabarsky et al., 2008 ) 4 prospective studies, ( Abahamye, 2016 ;Messina et al., 2015 ;Musmar et al., 2014 ;Saha et al., 2017 ) 2 retrospective studies ( dos Santos, 2016 ;Ha et al., 2019 ) and one historical control study ( Dowson et al., 2019 ). One quantitative study incorporated more than one design ( Advani et al., 2019 ). ...
... Consequently, for some studies, transferability and applicability of findings to a diverse range of acute, aged, and primary care settings was potentially limited. Common survey questionnaires were not utilised in more than one of the studies where a survey was undertaken, for most of these studies, a novel author developed survey instrument was utilised ( Abbas et al., 2019 ;Abera et al., 2014 ;Cotta et al., 2014 ;Drekonja et al., 2019 ;Fehily et al., 2015 ;Greendyke et al., 2018 ;McGregor et al., 2015 ;Merrill et al., 2019 ;Monsees et al., 2018 ;Mostaghim et al., 2017 ;Scales et al., 2017 ;Sutthiruk et al., 2018 ;Toska and Geitona, 2015 ;Wilcock et al., 2019 ;Wilcock et al., 2018 ). -all urine cultures pre-3.7 post 1.5 ( P < 0.0001); 1.3 in continuation period (7-30-month post intervention) -total days of therapy pre-167.7 post 117.4 ( P < 0.001); 109 in continuation period ( P < 0.001). ...
... Most of the quantitative studies considered nursing knowledge about antimicrobial resistance, antimicrobial stewardship, or stewardship related activities ( Abbas et al., 2019 ;Abera et al., 2014 ;Cotta et al., 2014 ;Drekonja et al., 2019 ;Fehily et al., 2015 ;Greendyke et al., 2018 ;McGregor et al., 2015 ;Merrill et al., 2019 ;Monsees et al., 2018 ;Mostaghim et al., 2017 ;Sutthiruk et al., 2018 ;Toska and Geitona, 2015 ;Wilcock et al., 2019 ;Wilcock et al., 2018 ;Hale et al., 2017 ;Heath et al., 2016 ;Wilson et al., 2017 ;Gillespie et al., 2013 ;Advani et al., 2019 ;Olans et al., 2015 ;Kilpatrick et al., 2019 ;Hamdy et al., 2019 ;Goulopoulos et al., 2019 ). Twelve of the included intervention studies incorporated educational activities that involved nurses ( Hale et al., 2017 ;Heath et al., 2016 ;Wilson et al., 2017 ;Gillespie et al., 2013 ;Shah et al., 2019 ;Stuart et al., 2015 ;Zabarsky et al., 2008 ;Messina et al., 2015 ;Saha et al., 2017 ;Ha et al., 2019 ). ...
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.
... In a similar attempt to define nursing views and barriers to participation in AMS activities in general, the Scottish Antimicrobial Prescribing Group, a national clinical multidisciplinary forum that coordinates and delivers AMS in Scotland, developed and distributed a survey to all nurses and midwives in Scotland. 17 The purpose of the survey was to scope the current understanding of AMS and define the learning needs and support required for effective engagement with AMS activities, with the results to be used in the development of an AMS educational program for these health care professionals. 17 Similar to our results, participants described key challenges to participating in AMS activities to be time constraints and workload, lack of knowledge, changing nurse practice habits and attitudes, and the need for ongoing support from colleagues, management, and clinicians for nurses to participate in an AMS role on the ward. ...
... 17 The purpose of the survey was to scope the current understanding of AMS and define the learning needs and support required for effective engagement with AMS activities, with the results to be used in the development of an AMS educational program for these health care professionals. 17 Similar to our results, participants described key challenges to participating in AMS activities to be time constraints and workload, lack of knowledge, changing nurse practice habits and attitudes, and the need for ongoing support from colleagues, management, and clinicians for nurses to participate in an AMS role on the ward. 17 Using a 4-hour educational program to introduce the concept of AMS to nursing staff, Edwards et al attempted to determine nurses' educational needs prior to participation in an AMS program. ...
... 17 Similar to our results, participants described key challenges to participating in AMS activities to be time constraints and workload, lack of knowledge, changing nurse practice habits and attitudes, and the need for ongoing support from colleagues, management, and clinicians for nurses to participate in an AMS role on the ward. 17 Using a 4-hour educational program to introduce the concept of AMS to nursing staff, Edwards et al attempted to determine nurses' educational needs prior to participation in an AMS program. 18 Several themes necessary for nurses to be meaningfully incorporated into the hospital's AMS program were identified. ...
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.
... Consequently, nurses are also most likely to identify and intercept errors in a timely manner (Hughes, 2008). However, research demonstrates that they do not do this knowingly under the auspices of AMS (McGregor et al., 2015). Considering the concerted efforts that have been made over the past decade to enhance AMS globally, there is little mention or consideration of the role of the nurse in guidelines for the development of AMS programmes (Mostaghim et al., 2017). ...
... Given the limited focus on the role of the nurse in AMS, it is unsurprising that there is little empirical evidence to draw upon which explores the nurses understanding, knowledge and/or experiences of AMS. One mixed methods study using a paper-based survey and face-to-face questionnaire across nursing and midwifery in 14 NHS regions in Scotland explored understanding of AMS among nurses and midwives (McGregor et al., 2015). A total of 901 qualified nurses and midwives completed either the paper-based or face-to-face questionnaire, around half of whom worked in an acute setting and half in a community setting. ...
... Our evaluation found that most students agreed that AMS is relevant to pre-registration nursing education and believed that the content covered in the education session was relevant to them as nursing students. This therefore complements the view of registered nurses that AMS knowledge and understanding should be incorporated into undergraduate nursing programmes (McGregor et al., 2015). There is evidence to suggest that there is untapped potential in engaging nurses and nursing students in AMS education; however, despite this very few institutes seem to have included this within their curriculum (Castro-Sanchez et al., 2016;Olans et al., 2015). ...
Background:
Antimicrobial resistance (AMR) is a global health concern. It is therefore imperative that healthcare professionals receive ongoing and relevant education and training to ensure they are competent in contributing to antimicrobial stewardship (AMS). At present, few undergraduate nursing programmes include AMS within their curriculum.
Objective:
The aim of the evaluation was to determine the relevancy of AMS within the undergraduate nursing programme through the perceptions of student nurses.
Methods:
A survey questionnaire was used to obtain undergraduate perceptions of AMS and the relevance to them and their clinical practice.
Results:
Our evaluation of this educational programme demonstrated that providing AMS education to undergraduate student nurses raises awareness of current challenges around AMR and reinforces the vital role nurses play in enhancing AMS and infection prevention and control.
Discussion:
This evaluation and current literature demonstrate a necessity for AMS to be embedded throughout undergraduate nursing education. Additionally, there is also a requirement to develop clear educational pathways in AMS to ensure continued professional development and contribute towards the advancement of the nursing role in AMS. By doing so, we will continue to build capacity and capability for the future delivery of healthcare.
... 10 Though the strategy and aspiration might be that all nurses should contribute to AS activities, a Scottish study of nursing and midwifery staff (of which approximately half worked in an acute setting) reported that only one in five had heard of AS, and that the main challenge to nurses and midwives becoming more involved with AS to be lack of time due to workload pressures. 11 Others have found similar low levels of engagement activities with an AS role caused by low awareness of the components of AS programme and a need for appropriate education. 12 As a 750-bed teaching district general hospital we already have an AS programme that fulfils many of the criteria outlined in national standards, 13 though there is little active engagement with the general nursing profession. ...
... Our survey was based solely in an acute hospital setting so results cannot be easily compared with other surveys from across an acute and community/primary care work setting, 11 or from other countries. 12 We found only 25 (32%) of our staff rated their knowledge of antibiotics as 'good' or 'very good', similar to the proportion (36%) in a Scottish study. ...
... 12 We found only 25 (32%) of our staff rated their knowledge of antibiotics as 'good' or 'very good', similar to the proportion (36%) in a Scottish study. 11 Forty-three (54%) of our respondents had heard the term antimicrobial stewardship compared with only 22% from the Scottish study. As the latter study was undertaken in 2014, it is to be expected that more staff would recognise this term in 2017 due to its promotion and publicity over the past few years, 14 though as McGregor et al commented in 2014, and others since then, there still remains scope for education to improve knowledge in this area at undergraduate level and beyond. ...
Objectives
Our aim was to determine the views of nurses and midwives in an acute hospital regarding a potential role in an antimicrobial stewardship programme.
Methods
An online survey about antimicrobial stewardship was distributed to nursing and midwifery staff at the Royal Cornwall Hospitals NHS Trust. Descriptive statistics were used for analysis.
Results
Eighty responses were received. Forty-three (54%) claimed to have heard the term antimicrobial stewardship. Only seven (9%) had cause to look at the hospital’s antimicrobial guidelines at least once a week. Between 47 (60%) and 68 (87%) respondents agreed they should be involved in a range of stewardship roles. Constraints of time and workload, lack of knowledge and lack of adequate staff training were the three main perceived challenges to a wider role.
Conclusions
Staff in this survey recognise the potential for wider antimicrobial stewardship roles. They also identify challenges to undertaking these roles. Some of these barriers could be overcome by provision of education and support; hospital pharmacists may be able to assist with this role development.
... Increasingly, the provision and management of care is seen as integral to AMS activities with good nursing described as 'good antimicrobial stewardship' [19]. However, undergraduate nurse students [20] and qualified nurses [21][22] report a poor knowledge of antibiotics with many unaware of the term AMS [20,21]. Only 63% of undergraduate nursing programmes include AMS teaching with only 12% reported to include all AMS principles [23]. ...
... Increasingly, the provision and management of care is seen as integral to AMS activities with good nursing described as 'good antimicrobial stewardship' [19]. However, undergraduate nurse students [20] and qualified nurses [21][22] report a poor knowledge of antibiotics with many unaware of the term AMS [20,21]. Only 63% of undergraduate nursing programmes include AMS teaching with only 12% reported to include all AMS principles [23]. ...
STRUCTURED Summary
Background
Registered nurses perform numerous functions critical to the success of antimicrobial stewardship but only 63% of pre-registration nursing programmes include any teaching about stewardship. Updated nursing standards highlight nurses require antimicrobial stewardship knowledge and skills.
Aim
To explore the delivery of key antimicrobial stewardship competencies within updated pre-registration nursing programmes.
Method
A cross-sectional survey design. Data were collected between March and June 2021.
Findings
Lecturers from 35 UK universities responsible for teaching antimicrobial stewardship participated. The provision of antimicrobial stewardship teaching and learning was inconsistent across programmes with competencies in infection prevention and control, patient centred care, and interprofessional collaborative practice taking precedent over those pertaining to the use, management, and monitoring of antimicrobials. On-line learning and teaching surrounding hand hygiene, personal protective equipment, and immunisation theory was reported to have increased during the pandemic. Only a small number of respondents reported that students shared taught learning with other healthcare professional groups.
Conclusion
There is a need to ensure consistency in antimicrobial stewardship across programmes, and greater knowledge pertaining to the use, management and monitoring of antimicrobials should be included. Programmes need to adopt teaching strategies and methods that allow nurses to develop interprofessional skill in order to practice collaboratively.
... Institute of Health Professions, Boston, Massachusetts, 12 School of Nursing, University of São Paulo, ...
... There have been calls for nurses to be recognised as legitimate contributors to AMS team efforts [2][3][4][5].Unfortunately, nurse's role in these efforts, have received minimal mention in international and national policy [4,6,7,8,9,10]. It is reported that nurses' knowledge of antibiotics is poor [11,12], and that AMS taught in nurse undergraduate programmes is disparate or lacking [13]. ...
... However, undergraduate healthcare professional students in the UK receive disparate stewardship education with only two thirds of nursing programmes incorporating any AMS teaching and only 12% covering all of the recommended AMS principles [26]. Furthermore, although both undergraduate student nurses [28] and qualified nurses [29] believe that AMS is relevant to pre-registration nursing education, they report that they do not have a good knowledge of antibiotics, and many have not heard of the term AMS [28][29], with fewer nurses as compared to doctors or pharmacists aware of the term. [30]. ...
... However, undergraduate healthcare professional students in the UK receive disparate stewardship education with only two thirds of nursing programmes incorporating any AMS teaching and only 12% covering all of the recommended AMS principles [26]. Furthermore, although both undergraduate student nurses [28] and qualified nurses [29] believe that AMS is relevant to pre-registration nursing education, they report that they do not have a good knowledge of antibiotics, and many have not heard of the term AMS [28][29], with fewer nurses as compared to doctors or pharmacists aware of the term. [30]. ...
Background:
There is growing recognition by national and international policymakers of the contribution nurses make towards antimicrobial stewardship. Although undergraduate education provides an ideal opportunity to prepare nurses for antimicrobial stewardship roles and activities, only two-thirds of undergraduate nursing programmes incorporate any antimicrobial stewardship teaching and only 12% cover all the recommended antimicrobial stewardship principles. Nurses also report that they do not have a good knowledge of antibiotics, and many have not heard of the term antimicrobial stewardship.
Aim:
To provide international consensus on the antimicrobial stewardship competency descriptors appropriate for undergraduate nurse education.
Methods:
A modified Delphi approach comprising two online surveys delivered to an international panel of 15 individuals reflecting expertise in prescribing and medicines management in the education and practice of nurses; and antimicrobial stewardship. Data collection took place between February and March 2019.
Findings:
A total of 15 participants agreed to become members of the expert panel, of whom 13 (86%) completed round 1 questionnaire, and 13 (100%) completed round 2. Consensus was achieved, with consistently high levels of agreement across panel members, on six overarching competency domains and 63 descriptors, essential for antimicrobial stewardship practice.
Conclusion:
The competency descriptors should be used to direct undergraduate nurse education and the antimicrobial stewardship practices of qualified nurses (including those working in new roles such as Nursing Associates) due to the high levels of agreement reached on competency descriptors.
... 2015 McGregor et al. (16) Assessing knowledge of antimicrobial stewardship. ...
... In this respect, involving nurses in ASPs may promote opportunities to discuss treatments, indicate antimicrobials, and establish their duration, increasing even more the multidisciplinary and interdisciplinary management of ASPs. However, it is worth mentioning that nurses must be trained to appropriately perform their role (11)(12)(13)(15)(16)18,24) . ...
Objective: To investigate publications in the literature on the participation of nurses in antimicrobial stewardship programs. Method: Integrative review with search in the following databases: the Medical Literature Analysis and Retrieval System Online, the Latin American and Caribbean Center on Health Sciences Information, and the Cumulative Index to Nursing and Allied Health Literature. As inclusion criteria, full articles in Portuguese, English, or Spanish published between January 2007 and May 2018 were selected.Results: Of the 140 articles found, 12 met the inclusion criteria, and were organized into the following three categories: “nurses’ competencies in antimicrobials stewardship programs” (five articles), “lack of knowledge and need for training” (six articles), and “systemic action” (one article). Conclusion: Nurses may contribute significantly to antimicrobial stewardship programs; however, educational actions, studies, and public policies are necessary for their effective participation.
... These knowledge findings are in agreement with previously collected data from 2014 to 2019 [4][5][6] . In 2015, however, a survey conducted in Scotland among nurses and midwives highlighted how 75.8% of the sample had never heard of "antimicrobial stewardship" and did not know what definition to give the term [7] . ...
... 61 Hands-on training, using a collaborative approach, involving nursing leaders, and empowering nurses to be a member of the antimicrobial team, may help improve nurse confidence in AS activities and lead to improved outcomes. [62][63][64][65][66][67][68] The advantages of a virtual structure are that it is much easier to disseminate and it is a lowercost option. For example, study materials can be made available in a virtual format (self-study modules, pre-recorded webinars, newsletters, or tip sheets). ...
Background: Nurses are vital healthcare team members and are often underutilised in antimicrobial stewardship (AS) activities. Several nursing responsibilities, such as taking allergy history and obtaining cultures, already overlap with AS activities. Nurses can play a crucial role in promoting AS in resource-limited settings. This study was conducted to assess frontline staff nurses’ baseline attitudes and beliefs towards AS, and see if a virtual education campaign consisting of newsletters and tip sheets would affect those attitudes and beliefs. Methods: An online survey (pre-survey) was conducted of all in-patient nurses employed in the authors’ hospital on their attitudes and beliefs regarding AS. The survey consisted of 24 questions divided into three domains: demographic and practice information, nursing roles, and beliefs and attitudes towards AS programmes (ASP). After obtaining the results of the pre-survey, the authors started distributing monthly newsletters on various AS topics via email and posting them on a resource page. Topics included how to obtain an accurate allergy history, how to use microbiology results to help guide decisions, and stop therapy in cases of colonisation. The authors also distributed the same survey as a follow-up 6-month survey (post-survey) in March 2021 to gauge the impact of their virtual education efforts. Results: In total, 109 nurses working in the adult in-patient setting of the authors’ institution completed the pre-survey in September 2020, and 64 nurses completed the post-survey in March 2021. Overall, most nurses had a positive attitude towards AS tasks, and over 90% of those who responded in the pre-survey and post-survey agreed with the statement that nurses are antibiotic stewards, thought it was important or very important to obtain appropriate cultures, and understood the relationship between Clostridioides difficile and antibiotics. Most pre-survey respondents listed knowledge gaps in microbiology (47 out of 64 [86%]) and antibiotics (53 out of 64 [84%]) as well as scope of practice concerns (48 out of 64 [75%]) as barriers to nurse participation. The virtual education helped raise the familiarity with the ASP and more nurses in the post-survey said they were familiar with the stewardship programme compared with the pre-survey (48.4% versus 23.2%; p=0.001). Conclusions: This study showed that most nurses consider themselves antibiotic stewards and want to participate in AS activities; however, barriers to nursing involvement, such as lack of knowledge, scope of practice concerns, and time constraints, persist. Virtual education may be an option to increase nursing awareness and participation on ASPs in resource-limited settings.
... There is evidence available that has identified barriers to nurses engagement in AMS. These include AMS not being taught in undergraduate nurse education programmes [14][15], nurses reporting poor knowledge of antibiotics and AMS [16][17], professional relations and hierarchies [18], a lack of involvement by nurses into AMS programmes, a lack of empowerment in terms of interprofessional roles and teamwork, and a lack of clarity around the roles and responsibility of nursing within new AMS driven procedures [19]. Barriers to engagement in AMS activities must be addressed to successfully change behaviour. ...
Background
Antimicrobial resistance (AMR) is significantly affected by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible antimicrobial use, and is essential for limiting AMR. Nurses have an important role to play in this context. Aim: This study investigated the determinants of nurse AMS behaviours and the impact of past training.
Method
A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses (223 female; mean age = 44.45; SD = 10.77 years) from ten nationalities, with individual survey links sent via professional networks in 5 countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were quantitatively assessed using the Theoretical Domains Framework (TDF), and mapped to the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Analysis identified differences between nurses with and without AMS training. The influence of COVID-19 on AMS behaviour was qualitatively investigated using free text data.
Findings
Nurses performed all nine AMS behaviours, which were significantly higher (t(238) = -4.14, p < .001), by those who had training (M = 53.15; SD = 7.40) compared to those who had not (M = 48.30; SD = 10.75). Those with AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with ‘Skills’ and ‘Behavioural Regulation’ (e.g. ability to self-monitor and plan), shown to be the most predictive of AMS actions. Both of these domains are situated in the Capability construct of COM-B, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since COVID-19, regardless of previous training. Six core themes were linked to AMS: 1) Infection prevention and control, 2) Antimicrobials and antimicrobial resistance, 3) The diagnosis of infection and the use of antibiotics, 4) Antimicrobial prescribing practice, 5) Person-centred care, and 6) Interprofessional collaborative practice.
Conclusion
This research, has identified the significant benefit of nurse training on AMS behaviour, and its determinants. Those who had training, scored higher in all TDF determinants of behaviour, compared to those who had had no training, resulting in higher Capability, Opportunity and Motivation to perform AMS behaviours. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimise AMS behaviour, with a focus on developing skills and behavioural regulation.
... in antimicrobial stewardship. This role is endorsed by other healthcare professionals in the wider literature(Abbo et al., 2012;Firouzabadi & Mahmoudi, 2020;Greendyke et al., 2019).Antimicrobial stewardship education has traditionally targeted doctors and pharmacists(McGregor, 2015). There is a growing recognition that if nurses are to be empowered to fully contribute,including confident to raise concerns about antibiotic management practices, they must first obtain a greater knowledge of the subject area (Jones-Berry, 2018; Merrill et al., 2019). ...
Background:
Antimicrobial stewardship (AMS) has traditionally been the domain of doctors and pharmacists but there is a growing recognition that successful stewardship incorporates a multidisciplinary approach that includes nursing staff. This literature review explores nurses' perceptions of their role in antimicrobial stewardship within the hospital environment and provides new insights to inform future practice.
Methodology:
An integrative literature review was undertaken. Five academic databases were searched, which identified six relevant studies. Whittemore and Knafl's method for conducting an integrative review was followed. ENTREQ guidelines have been adhered to.
Findings:
Two themes were identified: nurses' working in partnership with other professionals and engagement in education.
Discussion:
Antimicrobial stewardship illustrates the role of the nurse within the wider multidisciplinary team regarding wider patient safety issues and the need for education to enhance this role.
Relevance to clinical practice:
Nurses have a clear role to play in antimicrobial stewardship but need to be fully cognisant of the issues involved. Further clarity on how nurses should enact this role in their complex working environments is required. It is essential that both student and qualified nurses are able to speak up in order to maximise patient safety, fulfil their professional duty and promote the overall effectiveness of AMS if they witness poor antibiotic management practices.
... Diante do exposto, nota-se que envolver o enfermeiro nos PGAs pode proporcionar momentos para discutir o tratamento, a indicação e a duração dos antimicrobianos, aumentando ainda mais o gerenciamento multidisciplinar e interdisciplinar do PGAs. Porém, ressalta-se o fato de que para exercer adequadamente a função, os enfermeiros precisam ser capacitados (11)(12)(13)(15)(16)18,24) . ...
Objetivo: investigar na literatura publicações acerca da participação do enfermeiro nos programas de gestão do uso de antimicrobianos.Método: revisão integrativa com busca nas bases de dados: Medical Literature Analysis and Retrieval System on Line, Literatura Latino-Americana de Ciências da Saúde e Cumulative Index to Nursing and Allied Health Literature. Como critérios de inclusão, foram selecionados artigos disponíveis na íntegra, publicados entre janeiro de 2007 e maio de 2018, nos idiomas português, inglês ou espanhol.Resultados: foram encontrados 140 artigos, 12 atenderam aos critérios de inclusão, e foram organizados em três categorias: “competências do enfermeiro nos programas de gestão do uso de antimicrobianos” (cinco artigos), “déficit de conhecimento e necessidade de capacitação” (seis artigos) e “ação sistêmica” (um artigo).Conclusão: os enfermeiros podem contribuir de forma substancial com os Programas de Gerenciamento do uso de Antimicrobianos, porém são necessárias ações educacionais, pesquisas e políticas públicas para que a sua participação seja efetiva.
... Olans and colleagues illustrated that among 900 publications on AMS, only 11 appeared in nursing journals, signifying the lack of literature available to nurses on AMS [27]. Additionally, in a survey to more than 900 nursing staff and midwives, only 36% classified their stewardship knowledge as "very good" or "good," and only 21% were familiar with the term "AMS" [28]. Due to this lack of knowledge, nurses are reluctant to challenge a prescriber's orders. ...
The Centers for Medicare and Medicaid Services (CMS) finalized a rule in October 2016 mandating long-term care facilities (LTCFs) to have antimicrobial stewardship programs (ASPs) in place by 2017. Although guidance exists for establishing ASPs in LTCFs, limited data exists on the "how". As comprehensive ASPs already exist in many acute-care hospitals (ACHs) and, with the known "sharing of patients" between both settings, extending ACH ASP expertise to LTCFs will not only aid LTCFs in complying with the CMS mandate, but will likely also facilitate in decreasing multi-drug resistant organisms and Clostridumdifficile infection rates in patients of both organizations. In this report, we provide a roadmap on how to implement ASPs in LTCFs, using examples from our own ACH's collaboration with local LTCFs to develop and sustain LTCF ASPs. We discuss critical elements to achieving successful LTCF ASPs, including the potential barriers and how to overcome them.
... Professional development within antimicrobial stewardship needs to be incorporated into undergraduate education [32,33] and have inter-professional alignment to promote the collaboration from an early career stage. Within antimicrobial stewardship practice, the only professional and competency frameworks that currently exist are for antimicrobial pharmacist [34] and all prescribers of antimicrobials [35]. ...
Background: The critical role of antimicrobial stewardship (AMS) in mitigating antimicrobial resistance cannot be overemphasized, especially during COVID-19 pandemic. This study aimed to understand the perception of physicians about AMS as it relates to their training and practice experience. Method: A phenomenological qualitative study design was employed, and data was collected using a semi-structured questionnaire-based interview of a purposive sample of practicing physicians in the federal capital territory of Nigeria. Eighteen physicians completed the interview and responded based on their perceptions and practice experience. Thematic analysis and coding of the data were performed through an iterative process. Results: 56% of the respondents were female physicians, 67% worked in a private hospital/clinic, and 44% have been practicing for 11 – 15 years. 83% of the respondents think auditing clinicians would promote antibiotics stewardship. 44% of the respondents were unaware of clinical guidelines for an empirical antibiotics prescription. 56% felt doctors were not provided thorough training on AMS. The participants suggest that AMS in Nigeria could be promoted through training of personnel, establishing antibiotics policy and protocol, cessation of over-the-counter sales of antibiotics, creating awareness, access to prompt laboratory investigation and inter-professional collaboration between physicians and pharmacists. They also believed inter-professional collaboration is necessary to achieve AMS. Conclusion: Physicians perceived a knowledge gap in AMS as a result of inadequate training and lack of clinical guidelines on antimicrobial stewardship in the healthcare system of Nigeria. Intensive education of healthcare providers and inter-professional collaboration are plausible approaches to improving antibiotic stewardship.
This GSK-sponsored symposium took place at the European Association for the Study of the Liver (EASL) International Liver Congress (ILC) on 23rd June 2022 in London, UK. The symposium was developed in collaboration with external experts, including people directly affected by hepatitis B infection, to help highlight priorities for communications between patients and healthcare professionals (HCPs) to ensure good patient outcomes. The panel members were Mark Douglas, a virologist at Westmead Institute for Medical Research, Sydney, Australia; Ahmed Elsharkawy, a consultant transplant hepatologist at the Queen Elizabeth Hospital in Birmingham, UK; Catherine Freeland, Public Health Programme Director at the Hepatitis B Foundation, Doylestown, Pennsylvania, USA; and Natalia Sadowska, who has chronic hepatitis B (CHB), and is a member of the GSK patient council. The symposium was a conversation between the panel members to help better understand the key patient communication priorities for people with CHB when interacting with their HCPs. Panel members discussed the disconnect between patients and their HCPs in information sharing and treatment decision-making. The symposium also explored the patient journey to diagnosis, patients’ fear of transmitting the virus to others, and the management of CHB in the current therapeutic landscape and the future as a functional cure becomes possible.
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.
Antimicrobial resistance has hit alarming proportions. The problem is accentuated by the fact that there are hardly any new agents in the pipelines. As a result, antimicrobial stewardship (AMS) has gained paramount importance in order to minimize the effect of growing resistance. At the heart of AMS is rapid diagnosis using a variety of available technologies designed to specifically identify the nature of infection. A number of studies have shown the positive impact these technologies could create. This chapter discusses some of the recent data on the impact of rapid diagnosis along with a brief description of the principles behind these developments. In addition, there is acceptance in the wider scientific community that the user base needs to be adapted to allow maximum output from the scientific developments that have taken place. Finally, there are specialized aspects of AMS such as antifungal stewardship and antimicrobial heterogeneity that deserve coverage. A global understanding of AMS is necessary, and this involves application of the scientific principles in routine clinical practice.
Exploring the Role of the Bedside Nurse in Antimicrobial Stewardship: Survey Results From Five Acute-Care Hospitals - William G. Greendyke, Eileen J. Carter, Elizabeth Salsgiver, Daniel Bernstein, Matthew S. Simon, Lisa Saiman, David P. Calfee, E. Yoko Furuya
To Be a CLABSI or Not to Be a CLABSI—That is the Question: The Epidemiology of BSI in a Large ECMO Population - Jessica L. Seidelman, Sarah S. Lewis, Kirk Huslage, Nancy Strittholt, Sheila Vereen, Chris Sova, Bonnie Taylor, Desiree Bonadonna, David Ranney, Utlara Nag, Mani Daneshmand, Deverick J. Anderson, Daniel J. Sexton, Becky A. Smith
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.
Antimicrobial stewardship programs are important preventative strategies to reduce hospital-acquired infection, typically involving medical and pharmacy staff. Because nurses are pivotal in administering medication prescribed by medical staff and filled by pharmacy staff, we assessed nursing attitudes and antimicrobial stewardship knowledge before and after an education intervention that focused on nursing involvement in antimicrobial management. This study supports involving nurses as a means of improving antibiotic stewardship.
The potential contribution nurses can make to the management of antimicrobials within an in-patient setting could impact on the development of antimicrobial resistance (AMR) and healthcare associated infections (HCAIs). Current initiatives promoting prudent antimicrobial prescribing and management have generally failed to include nurses, which subsequently limits the extent to which these strategies can improve patient outcomes. For antimicrobial stewardship (AS) programmes to be successful, a sustained and seamless level of monitoring and decision making in relation to antimicrobial therapy is needed. As nurses have the most consistent presence as patient carer, they are in the ideal position to provide this level of service. However, for nurses to truly impact on AMR and HCAIs through increasing their profile in AS, barriers and facilitators to adopting this enhanced role must be contextualised in the implementation of any initiative.