Elsevier

Nurse Education Today

Volume 60, January 2018, Pages 157-160
Nurse Education Today

Contemporary Issues
Antibiotic stewardship: The role of clinical nurses and nurse educators

https://doi.org/10.1016/j.nedt.2017.10.011Get rights and content

Highlights

  • Resistance to antibiotics is an increasing problem around the world.

  • Antibiotic stewardship is a multidisciplinary effort.

  • Nurses are well suited to implement antibiotic stewardship at the point of care.

  • Resources for nursing education about antibiotic stewardship is needed.

  • Educators could ensure success of antibiotic stewardship by empowering nurses.

Introduction

Within 10 years of the breakthrough development of Penicillin, antibiotic resistance was reported. According to the Centers for Disease Control (CDC) and Prevention (CDC, 2017), each year 2 million cases of antibiotic resistant bacteria occur resulting in approximately 23,000 deaths in the United States. The World Health Organization (WHO) also reports that approximately 25,000 people die from antibiotic resistant organisms annually in the European Union (WHO, 2014). To combat these alarming trends, antibiotic stewardship (AS) programs have been strongly recommended by the WHO, the National Institute for Health and Care Excellence (NICE) Centers for Disease Control and Prevention (CDC), the International Society of Infectious Diseases, Infectious Disease Society of America, the Society for Healthcare Epidemiology of America, the American Society of Health System Pharmacists, and The Joint Commission (Centers for Disease Control and Prevention, 2017, National Institute for Health and Care Excellence, 2016).

Antibiotic stewardship (AS) refers to strategies that limit use of antibiotic agents to the minimum necessary spectrum and duration in conditions for which antibiotics are indicated (CDC, 2017). Some goals of AS are to reduce the development of antibiotic resistance and to improve patient outcomes. A common perception among nurses is that AS is a problem to be addressed by prescribing providers or pharmacists. In reality, because AS affects all venues of patient care (outpatient, inpatient, and long-term care), nurses across the healthcare continuum have an opportunity to play an important role in AS (Manning et al., 2016, Olans et al., 2016).

Successful antibiotic stewardship programs (ASP) utilize a multidisciplinary approach. The CDC Core Elements for Hospital AS suggest that nurses be involved in these multidisciplinary efforts, yet do not elaborate on optimal nursing activities within ASP (CDC, 2017). Although the role of nursing in AS has not been well developed, nurses are uniquely suited to implement successful AS measures at the point of care (Edwards et al., 2011). Further, nurse educators are in a position to promote AS and thereby improve patient outcomes. The aim of this paper is to provide an overview of the current literature related to the role of clinical nurses in AS and identify specific education implementation strategies to support nurses in AS.

Section snippets

Antibiotic Stewardship and Nurses' Role

There is limited published information about the role of nurses in AS and no research studies published about the effect of the nurses' role in AS (Edwards et al., 2011, Manning et al., 2016, Olans et al., 2016). Manning et al. (2016) outlined specific recommendations for action for practice, education, research and policy related to nurses' role in AS (Manning et al., 2016). Many of these recommendations have yet to be implemented. For example, nurses at all levels across all clinical settings

Future Directions and Implications for Nurse Educators

In an effort to comply with AS recommendations and in consideration of best practice, nurse educators need to identify opportunities and provide the support and education required to enable staff nurses to participate in a meaningful way to promote better patient outcomes. AS is an important interdisciplinary program. For AS to be successful, nurse educators must champion staff nurses by providing adequate budget, education and time for AS in their environment.

Conclusion

The aim of this paper was to provide an overview of current literature related to the role of clinical nurses in AS and identify specific education implementation strategies to support nurses in AS. Antibiotic stewardship is an important multidisciplinary initiative. Nurses have a significant role to play in AS. Ideally, the gold standard for AS would be nurses at the bedside who promote responsible, targeted, antibiotic use by being able to identify the patients' pathogen, verify that the

Conflicts of interest

None to declare.

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    Although nurses understand allergy reporting is essential, and admission questions about the presence of antimicrobial allergies are standard of care, they may not understand the need to verify true allergies, and there may not be processes in place to support more detailed allergy information gathering.18 One recent study suggested the use of scripting, structured allergy questionnaires, and patient education to elicit the true nature of antimicrobial allergies.10 Increased nursing focus on accurate allergy documentation represents a significant potential benefit to AS programs.

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This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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