RESUMO
BACKGROUND: Antimicrobial resistance has become one of the world's most important public health problems. Accordingly, nursing strategies to manage antimicrobials in hospital environments are fundamental to promoting patient health. The aim of this study was to summarise the best evidence available on nursing strategies for the safe management of antimicrobials in hospital environments. METHODS: This qualitative systematic review used meta-aggregation in accordance with the recommendations of the Joanna Briggs Institute. The protocol was registered in the data base of the Prospective Register of Systematic Reviews under No. CRD42021224804. The literature search was conducted, in April and May 2021, in the following data bases and journal repositories: Latin American and Caribbean Health Sciences Literature (LILACS) via the Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System on-line (Medline) via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scientific Electronic Library Online (SciELO) and Excerpta Medica Database (EMBASE). The findings of each study were summarized and the results were meta-aggregated in JBI SUMARI software. RESULTS: The search resulted in a total of 447 studies and, after selection, the review included 26 studies, in which 42 nursing strategies were identified. The strategies were first categorised as care- or stewardship-related and then into the subcategories: Screening, Administration, Monitoring and Discharge, Nursing Team, Multi-professional Teams, Patients and Institutional Leadership. The 42 strategies were meta-aggregated and represented in flow diagrams. The best evidence was synthesized related to nursing strategies in the safe management of antimicrobials in the hospital environment. CONCLUSIONS: Nurses play an indispensable function in antimicrobial stewardship in the hospital environment, because they work directly at the core of safe patient care. Significant contributions by nursing towards reducing antimicrobial resistance were found in care-related practice, education activities, research and policy.
RESUMO
OBJETIVO: identificar as estratégias para o uso seguro de antimicrobianos adotadas pela enfermagem no ambiente hospitalar. MÉTODO: revisão integrativa, realizada no período de junho a julho de 2020, nas bases de dados da LILACS, MEDLINE, CINAHL e EMBASE. Selecionaram-se artigos de 2015 a junho de 2020. Para a análise dos níveis de evidência, adotou-se o método Grading of Recomendations Assessment, Developing and Evaluation. RESULTADOS: encontraram-se oito artigos, distribuídos em estratégias gerenciais e assistenciais de enfermagem, relacionadas ao uso seguro de antimicrobianos. DISCUSSÃO: dentre as principais estratégias gerenciais, destacam-se o papel de educador do enfermeiro e a formação de comitês de monitoramento multidisciplinar; e dentre as assistenciais, as especificidades técnicas da administração de antimicrobianos. CONCLUSÃO: as principais estratégias práticas de Enfermagem encontradas foram educação profissional no uso racional e monitoramento multidisciplinar na resistência antimicrobiana no ambiente hospitalar. Acredita-se que a identificação dessas estratégias contribua para o desenvolvimento de melhores práticas na segurança medicamentosa.
OBJECTIVE: to identify the strategies for the safe use of antimicrobials adopted by Nursing in the hospital environment. METHOD: an integrative review, carried out from June to July 2020, on the LILACS, MEDLINE, CINAHL, and EMBASE databases. Articles from 2015 to June 2020 were selected. For the analysis of the evidence levels, the Grading of Recommendations Assessment, Development and Evaluation was adopted. RESULTS: eight articles were found, distributed in Nursing management and care strategies, related to the safe use of antimicrobials. DISCUSSION: among the main managerial strategies, the role of the educator and the setting up of multidisciplinary monitoring committees stand out; and, among the care strategies, the technical specificities of antimicrobial stewardship. CONCLUSION: the main Nursing practical strategies found were professional education in the rational use and multidisciplinary monitoring of antimicrobial resistance in the hospital environment. It is believed that the identification of these strategies will contribute to the development of better practices in drug safety.
OBJETIVO: identificar las estrategias para el uso seguro de antimicrobianos adoptadas por la enfermería en el ámbito hospitalario. MÉTODO: revisión integradora, realizada de junio a julio de 2020, de las bases de datos de LILACS, MEDLINE, CINAHL y EMBASE. Se seleccionaron artículos de 2015 a junio de 2020. Para el análisis de niveles de evidencia se adoptó el método Grading of Recomendations Assessment, Developing and Evaluation. RESULTADOS: se encontraron ocho artículos, distribuidos en estrategias gerenciales y asistenciales de enfermería, relacionados con el uso seguro de antimicrobianos. DISCUSIÓN: entre las principales estrategias gerenciales se destaca el rol de la enfermera educadora y la conformación de comités de seguimiento multidisciplinarios; y entre las asistenciales, las especificidades técnicas de la administración de antimicrobianos. CONCLUSIÓN: las principales estrategias prácticas de enfermería encontradas fueron la formación profesional en el uso racional y el seguimiento multidisciplinario de la resistencia a los antimicrobianos en el ámbito hospitalario. Se cree que la identificación de estas estrategias contribuye al desarrollo de mejores prácticas en seguridad de medicamentos.
