Facilitating nursing engagement with antimicrobial stewardship

Fiona Gotterson1, A/Prof Kirsty Buising2, Prof Elizabeth Manias3

1 National Centre for Antimicrobial Stewardship, University of Melbourne

2 Victorian Infectious Diseases Service, Royal Melbourne Hospital; National Centre for Antimicrobial Stewardship, University of Melbourne

3 Deakin University, Faculty of Health, School of Nursing and Midwifery; The University of Melbourne, The Royal Melbourne Hospital; The University of Melbourne, Melbourne School of Health Sciences

 

Antimicrobial stewardship (AMS) aims to change antimicrobial prescribing behaviour to ensure optimal use of antimicrobials, to promote patient safety and best outcomes for patients, to reduce adverse effects of antimicrobial use (including resistance), and to reduce health care costs. Changing antimicrobial prescribing behaviour is complex. A range of approaches is required, focussed not only on the act of prescribing, but also on all aspects of antimicrobial management including: administration, patient monitoring and review, and health professional and patient education. AMS must also be incorporated into wider infection prevention and control efforts. All these are integral aspects of nursing practice, but somewhat surprisingly, nurses have been largely excluded from discussions and research concerning AMS.

Drawing on findings from the literature, this presentation examines an alternative view of AMS, which includes nurses as legitimate participants, and explores potential approaches to nursing engagement. While education is essential, if nurses are to engage with AMS, core nursing values of patient centred care need to be considered. Consideration needs to be given to nurses’ place and voice within the multidisciplinary team, which may differ within and across settings. Local cultures and context also play an influence. Importantly, strategies to facilitate nursing engagement in AMS need to fit with nursing workflow, so that nurses’ involvement is not perceived as a burden.  The role of behaviour change theory is considered, to inform the development of AMS programs that are more inclusive of nurses. Case examples are also presented for discussion.