922. Barriers to Pediatric Staff Nurse Participation in Antimicrobial Stewardship Programs (ASP) Linked to Organizational Culture
Session: Oral Abstract Session: Bacterial Infections and Antimicrobial Stewardship
Friday, October 5, 2018: 9:45 AM
Room: S 156

Background:   Increasing nurse engagement in Antimicrobial stewardship programs (ASP) is a national initiative. We previously reported results from a stewardship survey where nurses indicated being confident to perform ASP practices, yet identified barriers to stewardship participation. Seventeen barriers were identified, with many centered around hospital culture such as lack of inclusion in rounds, power differentials, and nurse input not actively sought. To further understand organizational and cultural barriers which may influence nursing stewardship engagement, we used responses from the Agency for Healthcare Research and Quality (AHRQ) Patient Safety survey to evaluate nursing perception on hospital culture.

Methods:   Data from the 2017 AHRQ survey were used.  Nurses working on non-inpatient floors (e.g. post anesthesia care units) were excluded. For this analysis, we included four domains pertinent to stewardship initiatives: communication, information exchange, teamwork within and across units. Composite scores within each domain were calculated. Scores were stratified by Intensive Care Nursery (ICN), Pediatric Intensive Care Unit (PICU), Oncology (Onc), medical-surgical (med-surg) units, and dual units (e.g. float pool).

Results: 424 nurses participated in the survey; 138 (33%) ICN, 90 (21%) PICU, 42 (10%) Onc, 168 (40%) med-surg, and 23, (5%) dual. The majority of nurses had been employed by the hospital for 0-5 years (237; 56%) with 76 (18%) having more than 15 years.  The majority of nurses expressed neutrality with communication. Approximately 20% disagreed with the level of information exchange. Nurses perceived teamwork within a unit more favorably than teamwork across units. Responses were relatively consistent across units.

Conclusion:  Successful ASP require interdisciplinary collaboration and communication. Barriers related to communicating and exchanging information may limit nursing engagement. Assessments already used at hospitals could potentially guide methods of integrating nurses into stewardship with AHRQ data offering another lens to assess factors influencing behaviors to steward. A thorough understanding of nurses’ perceived work climate may inform engagement strategies.


Elizabeth Monsees, MSN, MBA, RN, CIC, FAPIC, Patient Care Services Research, Children's Mercy Hospital, Kansas City, MO, Lori Popejoy, PhD, APRN, GCNS-BC, FAAN, Sinclair School of Nursing, University of Missouri, Columbia, MO, Jennifer Goldman, MD, MS, Children's Mercy Kansas City, Kansas City, MO, Mary Anne Jackson, MD, FIDSA, FPIDS, Pediatrics, Children's Mercy Hospital, Kansas City, MO and Brian R. Lee, MPH, PhD, Health Outcomes, Children's Mercy Kansas City and University of Missouri-Kansas City SOM, Kansas City, MO


E. Monsees, None

L. Popejoy, None

J. Goldman, None

M. A. Jackson, None

B. R. Lee, None

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