Nurses Can Play a Bigger Role in Antibiotic Stewardship Programs

On December 5, the Centers for Disease Control and Prevention (CDC) and the American Nurses Association (ANA) hosted a live webinar on the role of nurses in antibiotic stewardship.

The Infectious Diseases Society of America defines antibiotic stewardship as coordinated interventions designed to improve and measure the appropriate use of antibiotic agents by promoting the selection of the optimal antibiotic drug regimen, including dosing, duration of therapy, and route of administration. As a growing effort in health care, stewardship programs aim to reduce the unnecessary prescription and use of antibiotics. When patients are sick, antibiotics aren’t always the answer and are ineffective for viral and fungal infections. They should only be used to treat bacterial infections, and yet in 2016, a study conducted by CDC and Pew Charitable Trusts researchers found that at least 1 in 3 antibiotic prescriptions are given unnecessarily, resulting in 47 million excess prescriptions each year. In hospitals, the CDC notes that as many as 50% of antibiotic prescriptions are inappropriate.

The problem of overprescribing and misprescribing continues to fuel antibiotic resistance—leading to 2 million antibiotic-resistant infections and 23,000 deaths each year in the United States—and can result in adverse effects for patients, doing more harm than good. The CDC’s Core Elements of Hospital Stewardship Programs outlines how hospitals can implement elements such as leadership commitment, accountability, drug expertise, tracking, and reporting.

In a recent webinar hosted by Nursing Infection Control Education (NICE) Network, a collaboration between CDC, the ANA, and specialty nursing organizations, a panel discussed how nurses can play a role in carrying out antibiotic stewardship programs in hospitals. The discussion was based on a recent white paper published by the ANA entitled “Redefining the Antibiotic Stewardship Team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices.” Patient safety is the main issue driving improvements in antibiotic use, note the authors on the paper. When given antibiotics they don’t need, patients can experience adverse effects such as nephrotoxicity and changes in the microbiome that can make them more susceptible to infections from bacteria such as Clostridium difficile.

“The purpose of the workgroup is to explore how nurses can become more engaged and take a leadership role to enhance our nation’s antibiotic stewardship efforts,” the authors write. They call out barriers to nurse participation in such programs, including gaps in nurses’ knowledge and education on antibiotic stewardship. and the use of antibiotics in the 21st century. But because of nurses’ central role working closely with patients and their families in the hospital, the home, and the community, they can have a key role in optimizing antibiotic use. The authors contend, “As such, they can be educators, advocates, and ambassadors for widespread behavioral change to more vigilant antibiotic awareness in our society.”

From conducting initial patient assessments in triage to taking patient allergy history to obtaining cultures and administering antibiotics, the functions of a nurse already overlap in many places with antibiotic stewardship programs. For nurses to perform a greater role in stewardship efforts though, the workgroup highlights the need for more education and training to fill knowledge gaps on topics such as microbiology and infections versus colonization.

“The urgent need to improve appropriate, evidence-based antibiotic use cannot be overstated,” note the authors. “With the current worldwide expansion of multidrug-resistant organisms, the question is not whether to involve nursing in antimicrobial stewardship, but how.”