NURSES IN ANTIMICROBIAL STEWARDSHIP

Jo McEwen Advanced Nurse Practitioner

Antimicrobial Stewardship, NHS Tayside

NURSINGWORKFORCE:

• LargestprofessionalworkforcewithinHealthcare

• Regularclinicalreviewandengagementwithpatients

• Consistentroleatpointofcareforpatientsandfamilies

• Primaryroletoadministermedicationssafelyandeffectively

• NMCdutyofcaretoensurenoharm&patientsreceivethecorrect

medicine

Olans, Olans & De Maria, 2015 Clinical Infectious Diseases

WHERECANNURSES/MIDWIVESCONTRIBUTETOAMS?

NOEXTRAWORKINVOLVED!

NURSING/MIDWIFERYINFLUENCEINANTIMICROBIALSTEWARDSHIP

McEwenJ.&BurnettE.AntimicrobialStewardshipandpre-registrationstudentnurses:Evaluationofteaching.JournalofInfectionPrevention,2017.https://doi.org/10.1177/1757177417726156

INTERNATIONALPERSPECTIVE

CURRENT NURSING AMS INVOLVEMENT IN UK §  National audit & feedback

§  Penicillin allergy review

§  Education & awareness – pre & post registration

§  Bacteraemia review – SABs & Gram -ve

§  Antimicrobial stewardship rounds

§  Bone & joint infection rounds

§  International AMS collaboration

§  Health & Social Care Integration

§  R&D

§  Policy & strategic direction

UK PERSPECTIVE – WHAT’S TO COME

ANTIMICROBIAL STEWARDSHIP IN NURSING

CLINICAL PRACTICE

AMSNURSINGROLECOMMUNITYHOSPITAL

 12montheducationprogrammefornurses

 Mosthospitalspredominantlynurseled

 GP&Pharmacyinputvariable(dailyinonewardonly)

Aims

 Increasenursingknowledge

 Reducenumberofinappropriateurinesamplessenttothelab

Measurables

 Pre-test/post-testquestionnaire

 Numberofurinesamplessenttolab

Question Pre-testresult Post-testresult Pvalue

Iknowwhatantimicrobialstewardshipmeans 50%Agree36%Disagree14%Unsure

96%Agree4%Disagree

0.019

Ihavesufficientknowledgeofantibioticstoasktheprescriberquestionsaboutantimicrobialprescriptions

68%Agree23%Disagree9%Unsure

92%Agree8%Unsure

0.01

Iknowwhatismeantbyempiricantibiotictherapy 23%Agree54%Disagree23%Unsure

76%Agree4%Disagree20%Unsure

0.00003

UrinalysisisareliabletoolinthediagnosisofUTIinolderadultsandcatheterisedpatients

27%Agree64%Disagree9%Unsure

92%Disagree4%Agree4%Unsure

0.019

Antibioticresistanceonlyaffectsthepersonwhohasreceivedtheantibiotics

45%Agree18%Disagree41%Unsure

20%Agree76%Disagree4%Unsure

0.029

IknowwhichantibioticsareclassedashighriskintermsofpromotingresistanceorC.difficileinfection

73%Agree23%Disagree4%Unsure

92%Agree8%Unsure

0.013

Results

Knowledgedoesnotalwaysresultinbehaviourchange

IMPACTONPRACTICEQuestion Response

Hasthesessiononantimicrobialstewardshipbeenbeneficialforyournursingpractice? 100%Yes

Sinceattendingtheeducationalsessiononantimicrobialstewardship,Inowfeelmoreconfidentinmyroleinthemanagementofinfections.

95.24%Yes4.76%Nochange

Canyouprovideanexampleofwhereyouhaveusedtheareasofnursinginfluenceorprinciplesofantimicrobialstewardshipinclinicalpractice?Qualitativethemes

•  End date antibiotic prescriptions •  Urinalysis no longer used as diagnostic tool for UTI •  Questioning inappropriate sample requests •  Review lab results for sensitivities

URINESAMPLES  Statisticallysignificantreductioninurinesamplessenttothelabsfrommean20.9to14.9samplesper1000OBD(p=0.009)§ 29%overallreduction§ Marginalcostsaving§ Preventionofantimicrobialprescriptions

UCL

LCL

0

5

10

15

20

25

30

Sep-14

Oct-

14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-

15

Apr-

15

May-

15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-

15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-

16

Apr-

16

Urine Samples Sent for Culture from Community Hospitals 9/14 – 4/16

No.

of U

rine

Sam

ples

per

10

00 O

BD

s

Antimicrobial Stewardship Programme introduced

UNDERGRADUATENURSINGEDUCATION

 Educationintroducedtoundergraduatenursingprogramme2014

 FirstSchoolofNursingtoincludeAMS

 AMSeducationdeliveredin3rdyr

 Blendedteachingmethods

 IncorporatesallprinciplesofAMS,microbiologyandareasofnursinginfluenceinAMS

EVALUATIONOFUNDERGRADUATENURSINGEDUCATION

 Evaluation carried out 2016

 Quantitative & qualitative evaluation questionnaire

 10 questions and 3 statements

 All 13 questions had optional free text

 Survey completed by 167 students

RESULTSKNOWLEDGE&UNDERSTANDING

 15% of students aware of AMS pre-lecture rising to 79% post-lecture

“Nurses&studentsspendmosttimewith

patients&arekeyfactor

inpatienteducation”

“Students are not in

a position to

challenge a

prescriber”

APPLICATIONTOCLINICALPRACTICE

 92%believedthatnurseshaveanimportantroletoplayinAMS

 71%couldidentifywheretheycouldcontributetoantimicrobial&infectionmanagement

 38%felttheirpracticehadchanged

“Promote IPC with colleagues”

RELEVANCETOPRE-REGISTRATIONPROGRAMME

 84%feltthatAMSrelevanttoundergraduatenursingeducation

 73%feltmoreconfidentinaskingaboutantimicrobialprescriptions

HOPESFORTHEFUTURE-SYNERGY….

CastroSanchezEM,GilchristM,McEwenJ,SmithM,KennedyH,HolmesA.,2017,Antimicrobialstewardship:wideningthecollaborativeapproach,JournalofAntimicrobialStewardship

@jomcewen1977