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.
P. Zachariah, None
E. Y. Furuya, None
E. J. Carter, None