1893. Barriers and Facilitators to Nursing (RN) Involvement in Antibiotic Stewardship (AS): Multisite Qualitative Study of Prescribers
Session: Poster Abstract Session: Antimicrobial Stewardship: Qualitative Research
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • RN stewardship ID Week Poster FINAL.pdf (661.4 kB)
  • Background: The Centers for Disease Control and Prevention and the American Nurses Association (CDC/ANA) outline specific responsibilities for RNs in AS efforts. Responsibilities expand traditional RN roles and are perceived to require prescriber engagement. We explored prescribers’ attitudes towards RNs’ involvement in AS and barriers and facilitators to the following RN responsibilities specified by the CDC/ANA: 1) RNs facilitate accurate antibiotic allergy histories; 2) RNs encourage the switch from intravenous (IV) to oral (PO) antibiotics; and 3) RNs initiate an antibiotic time out with prescribers.

    Methods: 4 focus groups and 2 interviews with 37 prescribers (10 medicine residents, 10 adult hospitalists, 9 pediatricians, and 8 critical care nurse practitioners) were conducted between July 2017 and March 2018 at 2 academic adult and pediatric hospitals. Transcripts were coded using a conventional content analysis in NVivo 11.

    Results: Prescribers agreed that RNs should play an important role in AS and described positive experiences when interacting with RNs who actively aimed to improve antibiotic use. While CDC/ANA recommendations were perceived to improve patient care, recommendation-specific challenges were noted to pose important barriers: 1) understanding that RNs are not exclusively responsible for antibiotic allergy histories; 2) possible prescriber pushback if the rationale for an IV to PO switch and the potential severity of the problem locally is not well understood; and 3) competing RN and prescriber schedules and a lack of clearly defined RN roles during antibiotic timeouts. To overcome barriers, prescribers recommended: 1) RNs initiate conversations with prescribers re: questionable drug allergies to facilitate accurate documentation and shared responsibility of drug allergy information; 2) prescriber education and the sharing of local data to address prescriber pushback; and 3) integration of antibiotic timeouts during interprofessional rounds and specified RN responsibilities to ensure meaningful conversation.

    Conclusion: Prescribers were receptive to formal RN involvement in AS activities, but noted the successful adoption of CDC/ANA recommendations would require an interprofessional approach.

    William Greendyke, MD1,2, Alexandra Shelley, MS, RN-BC, FNP-BC3, Philip Zachariah, MD, MS2,4, E. Yoko Furuya, MD, MS1,2 and Eileen J. Carter, PhD, RN5,6, (1)Medicine, Columbia University Medical Center, New York, NY, (2)Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, (3)New York Presbyterian/Lower Manhattan Hospital, 170 William Street, Rm 5-55, NY, (4)Pediatrics, Columbia University Medical Center, New York, NY, (5)Columbia University School of Nursing, New York, NY, (6)NewYork-Presbyterian Hospital, New York, NY

    Disclosures:

    W. Greendyke, None

    A. Shelley, None

    P. Zachariah, None

    E. Y. Furuya, None

    E. J. Carter, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.