1826. Interventions to Enhance Clinical Nurse Partnership in Acute Care and Nursing Home (NH) Antibiotic Stewardship Efforts: a Scoping Review
Session: Poster Abstract Session: Antimicrobial Stewardship: Non-hospital Settings
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • RN_AS_Scoping_IDweek_FINAL_9.25.18.pdf (779.5 kB)
  • Background: Nurses are called upon to partner in antibiotic stewardship programs (ASPs). Yet, the nurses’ role in ASPs and measures of nurses’ contributions to ASPs are poorly defined. 

     

    Methods: Scoping review to explore 1) interventions to enhance nurses’ role in optimizing antibiotic use in the inpatient and nursing home (NH) settings and 2) measures to quantify intervention impact. We searched the PubMed, CINAHL, Embase, and Cochrane Library databases for articles published between 2005 and October 2017. We included studies that targeted clinical nurses to improve the appropriateness, timing, and duration of antibiotics. Two researchers reviewed titles, abstracts and extracted data from eligible full-texts.

     

    Results: Sixteen studies met inclusion criteria (Figure). Among studies, 10, 5, and 1 were conducted in the NH, inpatient or several settings, respectively. Nearly all studies (N=15) incorporated nurses into interprofessional efforts to improve antibiotic use. Thirteen studies aimed to improve antibiotic appropriateness. Of these, 6 educated nurses in culturing technique and/or appropriateness; 5 educated nurses in antibiotic treatment guidelines; and 2 incorporated nurses into audit and feedback mechanisms. Six studies aimed to improve the timeliness of antibiotic administration. Of these, all included education on the importance of prompt antibiotic administration; 2 improved antibiotic availability and 1 enabled nurses to administer antibiotics before a provider’s evaluation. Two studies, both conducted in the NH, aimed to improve the duration of antibiotics by having nurses track the days of antibiotic therapy or remind prescribers to use treatment guidelines. Non-prescribing outcomes (e.g., timeliness of culture specimens and antibiotic administration, etc.) were evaluated in 7 studies and significant improvements were consistently found. Prescribing outcomes (e.g., antibiotic use, appropriate antibiotic use, etc.,) were evaluated in 12 studies and 8 studies identified significant improvements.

     

    Conclusion: Nurses may successfully contribute to improved antibiotic use. Further research is needed to clarify the nurses’ role in ASPs and to develop validated measures of nurses’ contributions. 

     

    Eileen J. Carter, PhD, RN, New York Presbyterian Hospital, New York, NY, Alexandra Shelley, MS, RN-BC, FNP-BC, New York Presbyterian/Lower Manhattan Hospital, 170 William Street, Rm 5-55, NY, Rita Olans, DNP, CPNP, APRN, Nursing, Massachusetts General Hospital- Institute of Health Professions, Boston, MA, Johanna Goldberg, MSLIS, Columbia University Medical Center, 701 West 168th Street, NY, David P. Calfee, MD, MS, Weill Cornell Medicine, New York, NY and Elaine Larson, RN PhD, School of Nursing and Epidemiology, Columbia University, New York, NY

    Disclosures:

    E. J. Carter, None

    A. Shelley, None

    R. Olans, None

    J. Goldberg, None

    D. P. Calfee, None

    E. Larson, None

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