Bedside Nurses Can Make a Big Difference in Antimicrobial Stewardship, Study Finds

A new study finds health systems can make significant strides in their antimicrobial stewardship and infection prevention efforts by enlisting a resource every hospital already has: bedside nurses.

The research, published last month in The Joint Commission Journal on Quality and Patient Safety, is based on a recommendation by the Joint Commission that frontline clinicians need to be more involved in antimicrobial stewardship.

In order to find out just how and whether that would work, investigators in California partnered with a community regional medical center to construct a multidisciplinary approach to antimicrobial stewardship and infection prevention built around nurses’ rounds in the medical center’s telemetry unit. The rounds were overseen by a nurse coordinator and attended by an infectious disease pharmacist, an infection preventionist, and a nurse practitioner. After 12 months, investigators compared key data with the same data points from the 12 months prior to the program’s initiation.

Investigators found the telemetry unit’s antimicrobial use dropped by 94 days of therapy per 1000 patient days, acid suppressant medication use fell from 708.1 days per 1000 patient days to just 372.4 days, and urinary catheter use was cut by one-third.

David R. Ha, PharmD, BCIDP

Corresponding David R. Ha, PharmD, BCIDP, assistant professor of clinical sciences at the Keck Graduate Institute, told Contagion® one of the secret to the program’s success was merely giving it a try.

“There is nothing special about what we did besides the fact that we were willing to try it and stick with it,” he said.

Ha said the approach was simple: “We got together a team of motivated individuals from various disciplines (nursing, infectious disease, pharmacy, infection prevention), centered them around a goal (antimicrobial stewardship and infection prevention), identified measures for success, agreed upon a process (nurse-driven rounds), executed that process, and continued to monitor the process and tweak it based on our findings.”

Although involving nurses in antimicrobial stewardship and infection prevention might seem straightforward, Ha said too often health systems tend to think of those tasks as merely a job for specialists.

“The current status quo for antimicrobial stewardship programs is involvement of ID pharmacists and ID physicians as well as microbiologists and infection preventionists,” he said. “[Although] these individuals are critical to successful programs, very few actively incorporate nurses, and that is the key word: ‘actively.’”

Ha said it makes sense for bedside nurses to play a role in evaluating and discussing patients’ antimicrobial therapies and making collaborative interventions as part of a multidisciplinary team. However, it rarely happens.

“The reality is that we still mostly operate in our silos, which stifles our collaborative potential,” he said.

Ha said he hopes the study serves as proof that such a program can work and as a guide of how to build one. He also hopes it raises awareness and leads to more health systems giving nurses a more prominent role in antimicrobial stewardship and infection prevention.

“Nursing practice and institutional structure is extraordinarily different from place to place,” he said. “We need more people to try new and innovative ways of involving their bedside nurses in antimicrobial stewardship so that we can identify best practices in this area.”