A behavioural approach to specifying interventions: what insights can be gained for the reporting and implementation of interventions to reduce antibiotic use in hospitals?

BACKGROUND: Reducing unnecessary antibiotic exposure is a key strategy in reducing the development and selection of antibiotic-resistant bacteria. Hospital antimicrobial stewardship (AMS) interventions are inherently complex, often requiring multiple healthcare professionals to change multiple behaviours at multiple timepoints along the care pathway. Inaction can arise when roles and responsibilities are unclear. A behavioural perspective can offer insights to maximize the chances of successful implementation. OBJECTIVES: To apply a behavioural framework [the Target Action Context Timing Actors (TACTA) framework] to existing evidence about hospital AMS interventions to specify which key behavioural aspects of interventions are detailed. METHODS: Randomized controlled trials (RCTs) and interrupted time series (ITS) studies with a focus on reducing unnecessary exposure to antibiotics were identified from the most recent Cochrane review of interventions to improve hospital AMS. The TACTA framework was applied to published intervention reports to assess the extent to which key details were reported about what behaviour should be performed, who is responsible for doing it and when, where, how often and with whom it should be performed. RESULTS: The included studies (n = 45; 31 RCTs and 14 ITS studies with 49 outcome measures) reported what should be done, where and to whom. However, key details were missing about who should act (45%) and when (22%). Specification of who should act was missing in 79% of 15 interventions to reduce duration of treatment in continuing-care wards. CONCLUSIONS: The lack of precise specification within AMS interventions limits the generalizability and reproducibility of evidence, hampering efforts to implement AMS interventions in practice.

Applying an antimicrobial stewardship competency framework in nurse education and practice.

Antimicrobial-resistant infections cause a significant number of deaths globally each year, and the development of resistance is influenced by the frequency of antibiotic use. This article describes an antimicrobial stewardship competency framework for undergraduate nurse education in the UK and internationally, explaining how this framework can be mapped to nurse education and training programmes. It also uses a case study to demonstrate how the competencies can be applied to nursing practice.

Antimicrobial stewardship and pre-registration student nurses: Evaluation of teaching.

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.

Assessing knowledge of antimicrobial stewardship.

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.