Annotated Bibliography: Antibiotic Stewardship

In patients on antibiotics, how effective is the implementation of formal participation of nurses in antibiotic stewardship activities, compared to no intervention, in achieving the fight against antibiotic resistance, over 6 months?

Annotated Bibliography: Antibiotic Stewardship

This study is at the first level of evidence, where clinical practice guidelines and carefully created statements are used to aid nurses and patients in determining care decisions. The guidelines are ideally a systematic evaluation of the literature, as well as the agreement of a group of professional decision-makers, including administrators, policymakers, physicians, and consumers, who weigh the evidence and offer recommendations.

The descriptive qualitative method was used in the research. The study’s goal was to investigate nurses’ and infection preventionists’ (IPs’) attitudes toward five of the ANA/CDC working group’s nurse-driven antibiotic stewardship activities: questioning the medical necessity of urine cultures, ensuring proper urine and blood culturing techniques, initiating the switch from intravenous (IV) to oral (PO) antibiotics, obtaining and recording an accurate penicillin drug allergy history, and initiating an anaphylactic reaction.

Focus groups and semi-structured interviews were conducted with clinical nurses and nurse managers who worked in general critical care units and medical-surgical units at two university hospitals in New York City that care for adult or pediatric populations. Convenience sampling was employed to select participants. When recruitment reached theoretical saturation, the trial was terminated. There is no clearly stated hypothesis in the study, as well as the research question.

Results of the study showed that nurses must play a significant role in antibiotic stewardship because their contributions to antibiotic optimization were an extension of their position as patient advocates. Again, nurses are well placed to maximize antibiotic use since they are the primary dispensers of antibiotics and are always present at the patient’s request. However, the study also reveals misgivings about nurses’ roles in antibiotic stewardship, highlighting that patients under the nurses’ care were critically ill and necessitated antibiotics.

Due to nurses’ restricted involvement in antibiotic prescription and the conviction that antibiotic orders are reviewed and approved by multiple personnel (such as doctors and pharmacists) prior to a nurse’s administration of antibiotics, the study calls into question nurses’ ability to make valuable contributions to antibiotic stewardship. The study is important to nursing practice as it tries to figure out the nurse’s contribution to fighting antibiotic resistance.

The study is at the sixth level of evidence, where a single descriptive technique systematically studies antibiotic stewardship among nurses utilizing an inductive approach and meaning exploration with the goal of understanding, describing, and exploring meanings and patterns employed by the nurses.

The study employs a single-centered, cross-sectional survey study, intending to assess how inpatient staff nurses see their position and their confidence in performing a specified set of nursing practices that support stewardship processes. The research was carried out in a 354-bed freestanding Midwestern pediatric hospital that has had an antibiotic stewardship program since 2008, employing a prospective audit and feedback technique to assist doctors to customize and optimize therapy.

An online poll was employed in the study, which highlighted nurse tasks that assist the stewardship process. The original list had 16 practices. Using a consensual method, ten practices routinely assigned to hospital nurses were chosen as practices of interest for the stewardship team.

According to the study, nurses’ roles in antimicrobial stewardship programs are not well defined. Nurses felt that their active engagement in antibiotic stewardship programs would be better if they were present in rounds regularly and had a formal role to perform, such that nurse advice on antibiotic decision-making was frequently asked.

The study also found that fresh graduate nurses cited a lack of knowledge as a barrier to participating in antibiotic stewardship, but more experienced nurses stated that their role in drug safety transformed as technology and procedures changed. For example, their practice shifted when unit-based pharmacists and automated electronic medical record drug dosage computations were available.

The study is significant in nursing practice because it concludes that it is vital to create an atmosphere in which nurses are enabled to lead, and opinion is sought. Changes in the health-care system influence nursing practice, implying that resources designed to assist clinical care may have unanticipated implications.

According to one of the nurses, the allocation of pharmacy as well as electronic resources has impacted the medication roles that nurses typically hold and may have reduced nurses’ vigilance in double-checking that prescription drugs are correct in terms of the appropriate drug, the appropriate time, the appropriate route, the appropriate dose, and for the appropriate individual.

References

  • Carter, E. J., Greendyke, W. G., Furuya, E. Y., Srinivasan, A., Shelley, A. N., Bothra, A., Saiman, L., & Larson, E. L. (2018). Exploring the nurses’ role in antibiotic stewardship: A multisite qualitative study of nurses and infection preventionists. American Journal of Infection Control, 46(5), 492–497.
  • Monsees, E., Popejoy, L., Jackson, M. A., Lee, B., & Goldman, J. (2018). Integrating staff nurses in antibiotic stewardship: Opportunities and barriers. American Journal of Infection Control, 46(7), 737–742. https://doi.org/10.1016/j.ajic.2018.03.028