Clinical Nurses are Active Partners in Antimicrobial Stewardship Efforts: Results from a Multisite Survey

Background:

Development of antimicrobial stewardship (AS) programs in acute-care hospitals is a continued area of interest. Because of their bedside responsibilities, clinical nurses (RNs) were previously identified as potentially critical team members in AS activities¹. Studies examining RNs’ knowledge, attitudes, and practices regarding AS are limited.

Methods:

Acute-care RNs at a 5 campus hospital system were invited to participate in an anonymous 30 question survey regarding principles of AS. RNs eligible for inclusion spent the majority of time in the inpatient setting or the emergency department (ED). RNs were excluded if their duties did not routinely include antibiotic administration (e.g., behavioral health).

Results:

451 (13%) of 3458 eligible RNs completed the survey. 40% of respondents worked in medical-surgical units, 39% in intensive care units, 11% in EDs, and 10% in step down units. Overall, 62% of RNs were unfamiliar with the phrase “antimicrobial stewardship.” However, 71% reported that they initiate discussions with prescribers regarding antibiotic dosing and duration. 85% reported that dedicated time to discussing antibiotics would be helpful, and 92% reported that discussion of antimicrobials with prescribers after finalization of a culture report would be beneficial to the patient. 16% thought that such a conversation could be implemented without difficulty, and 64% would like additional education regarding antibiotics and culture results. 40% of RNs reported regularly experiencing challenges administering antibiotics on time. 75% reported using two separate blood draws to collect blood cultures from a septic patient. 97% reported asking relevant follow-up questions to a patient reporting an allergy, although only 55% correctly identified a medication intolerance. 97% reported a desire to know more about the role RNs can play in AS.

Conclusion:

We identified that RNs regularly participate in activities essential to AS, and are enthusiastic about continued AS education. Further efforts and interventions to engage RNs as partners in AS activities are warranted.

1. Olans R, Olans RD, Demaria A. The critical role of the staff nurse in antimicrobial stewardship— unrecognized, but already there. Clin Infect Dis 2016; 62:84–9.