The Critical Role of the Staff Nurse in Antimicrobial Stewardship--Unrecognized, but Already There.

An essential participant in antimicrobial stewardship who has been unrecognized and underutilized is the "staff nurse." Although the role of staff nurses has not formally been recognized in guidelines for implementing and operating antimicrobial stewardship programs (ASPs) or defined in the medical literature, they have always performed numerous functions that are integral to successful antimicrobial stewardship. Nurses are antibiotic first responders, central communicators, coordinators of care, as well as 24-hour monitors of patient status, safety, and response to antibiotic therapy. An operational analysis of inpatient admissions evaluates these nursing stewardship activities and analyzes the potential benefits of nurses' formal education about, and inclusion into, ASPs.

Defining a Role for Nursing Education in Staff Nurse Participation in Antimicrobial Stewardship.

The role of the staff nurse in antimicrobial stewardship programs (ASPs) is not clearly defined. This study explored the ASP educational needs of staff nurses, using survey, focus group, and Delphi methods of engaging nurse educators. Low awareness of components of ASPs and areas of educational need were identified.

Florence Nightingale and Antimicrobial Stewardship.

Following the uniquely coincident Year of the Nurse and the year of the pandemic, striking similarities between the principles and innovations that Florence Nightingale introduced to nursing and the inclusion of nurses in the pursuit of antimicrobial stewardship have become evident. Issues of universal healthcare, the treatment of infections, workforce collaboration, and quality of care are as critical in the 21st century as they were in Nightingale's lifetime. The importance of nursing involvement in each of these areas is compared and discussed with their relevance to past, present, and future healthcare.

CE: Pediatric Antibiotic Stewardship.

ABSTRACT: With the rise of antibiotic resistance, antimicrobial stewardship programs can now be found in the ambulatory setting, where nearly 95% of antibiotic prescriptions originate. Judicious use of antibiotics is of particular importance to the ambulatory pediatric provider, as the annual antibiotic prescription rate is highest among children ages two and younger and inappropriate early-life antibiotic use is associated with elevated childhood risk of several medical conditions. While most ambulatory antibiotic stewardship programs have focused on shaping clinician behaviors to prevent unnecessary antibiotic prescribing, duration of antibiotic therapy has been found to be a critical, yet underexamined, facet of antibiotic use. In the past, duration of antibiotic therapy was largely based on convention and expert opinion, with little scientific evidence supporting many of the recommendations. Research suggests that many common pediatric infections such as acute otitis media, community-acquired pneumonia, streptococcal pharyngitis, and urinary tract infections can be effectively and safely treated with reduced courses of antibiotic therapy. In addition to reducing the incidence of antibiotic resistance, a shorter duration of antibiotic therapy may help prevent many adverse effects associated with antibiotic treatment. Current studies on the duration of antibiotic therapy, especially in pediatrics, are limited as they often rely on data extrapolated from adult studies that fail to consider the effects of age-related growth and development on both pharmacokinetics and pharmacodynamics. Future investigation into this topic is also limited by researchers' reliance on subsidies from pharmaceutical companies; clinicians' fear of undertreating infection; and hesitancy to deviate from current standards of care, even when such standards are not evidence based. Despite these challenges, the dangers of inappropriate antibiotic use in the pediatric population warrant further evaluation.

Implementing an Antimicrobial Stewardship Program in the Intensive Care Unit by Engaging Critical Care Nurses.

The continuing rise in the incidence of multidrug-resistant organism infections has made combating this grave threat a national imperative. One of the most potent weapons in our arsenal against such organisms is the prudent use of antibiotics. Antimicrobial stewardship (AMS) programs aim to slow the development of antimicrobial resistance through judicious, monitored use of antibiotics. Traditionally, AMS programs have included pharmacists and physicians with training in AWS, infectious disease physicians, hospital leadership, microbiologists, and infection prevention professionals. Nurses are missing from AMS programs, especially intensive care nurses. Critical care nurses provide the majority of patient care to ICU patients and monitor the progress of the patient's condition. The ICU nurse is an obvious asset to the AMS programs. ICU nurses are well-educated autonomous professionals with a unique role in coordinating with the critical care team. Critical care nurses already perform numerous nursing tasks with AWS functions. This, together with their unique perspective makes them a valuable asset that has often been overlooked. Traditionally, perceived barriers have kept ICU nurses from joining AMS teams. By removing these barriers and engaging critical care nurses in the important work of AWS, we can strengthen our AMS team and achieve optimal outcomes for our patients.

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.

A Multidisciplinary Approach to Incorporate Bedside Nurses into Antimicrobial Stewardship and Infection Prevention.

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.

Good Nursing Is Good Antibiotic Stewardship.

: Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The most promising approach to this national crisis is a new understanding of the need for the careful and responsible use of antibiotics, both for the benefit of society and for the optimal care of each patient. This multidisciplinary approach, called antimicrobial stewardship, has typically involved specialists but not necessarily nurses, who perform numerous antibiotic-related activities daily and should be an integral part of antimicrobial stewardship programs. In this article, we use patient examples to review several stewardship activities and illustrate how nurses are essential to the appropriate use of antibiotics.