Exploring the

Key Role

Nurses Play in

Antimicrobial

Stewardship

November 7, 2017

The Association for Registered Nurses of Newfoundland & Labrador

Teleconference Education Session

Mat Wenger RN BSc BScN CNCC(C)

Disclosures

None

Overview Antimicrobial Resistance (AMR)

Antimicrobial Stewardship (AMS)

Nursing Role in Antimicrobial

Stewardship

ICU Quick Reference Guide

Fear to Undertreat or Overtreat

Choosing Wisely

Antimicrobial

Resistance

3 Methods

Bacteria

Use to

Resist

Antibiotics

1. Efflux Pump

2. Neutralization

3. Modification(Longitude Prize, 2015)

Top Ten Most

Dangerous and

Antibiotic

Resistant

Bacteria

(Longitude Prize, 2014)

(Longitude Prize, 2014)

1 2

10

9

8

7

6 54

3

Compound Interest, 2014a)

(Edmond, 2017a)

Importance of

Antimicrobial

Stewardship

Successful stewardship depends on

nurses’ ongoing vigilance.

- Olans, Olans & Witt (2017)

Antimicrobial Stewardship

How Antimicrobial Stewardship Models Align with

Nursing Activities?

(American Nurses Association, 2017)

The critical role of the staff nurse in antimicrobial

stewardship—unrecognized, but already there.

Olans et al., 2016

1. Patient Admission

2. Daily Clinical Progress Monitoring

3. Patient Safety & Quality Monitoring

4. Clinical Progress/ Patient Education/

Patient Discharge

(Edmond, 2017b)

Nurses &

Antimicrobial

Stewardship

Nursing Role in

Antimicrobial

Stewardship

5 Key Strategies

to Influence AMS

In Your Practice

5 Key Strategies

1. Correct ABx information

2. Correct ABx route

3. Reassess ABx therapy

4. Review ABx therapy

5. Reconcile ABx

ICU Quick

Reference

Guide

Quick Clinical

Resource

Evidence Based

Collaboration

Distribution

ICU Quick Reference Guide

The

antibiotic

course

has

had

its

day

Fear to Undertreat or Overtreat

Llewelyn et al. (2017)

● Limited evidence to suggest

stopping treatment early contributes

to antibiotic resistance

● Replace “Complete Course” with

“Exactly as Prescribed”

● More evidence is needed to support

limited duration antibiotic trials

(Quality of Care NL, 2017a) (Quality of Care NL, 2017b) (Quality of Care NL, 2017c)

Final Thoughts Questions?

Thank YouWhat does AMS look

like in your area of

practice?

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in hospital antibiotic stewardship practices. Retrieved from http://www.nursingworld.org/ANA-CDC-AntibioticStewardship-WhitePaper

● Baur, D., Gladstone, B. P., Burkert, F., Carrara, E., Foschi, F., Döbele, S., & Tacconelli, E. (2017). Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a

systematic review and meta-analysis. The Lancet Infectious Diseases, 17(9), 990–1001. doi:10.1016/s1473-3099(17)30325-0

● Brunning, A. (2014). An overview of antibiotics. Retrieved from https://longitudeprize.org/blog-post/overview-antibiotics

● Compound Interest. (2014a). Different classes of antibiotics - an overview [Online image]. Retrieved September 2, 2017 http://www.compoundchem.com/wp-content/uploads/2014/09/A-Guide-to-Different-Classes-of-Antibiotics-Aug-15.png

● Compound Interest. (2014b). A brief overview of classes of antibiotics. Retrieved from http://www.compoundchem.com/2014/09/08/antibiotics/

● Droege, M. E., Van Fleet, S. L., & Mueller, E. W. (2016). Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis. Critical Care Nurse, 36(2), 22-32. doi:10.4037/ccn2016881

● Eastern Health. (2017). Hand Hygiene[Brochure]. Author. Retrieved April 18, 2017, from http://pulse.easternhealth.ca/Pages/ImageLoader.aspx?ResourceID=4653

● Eastern Health. (2017). IPAC Information for Staff[Brochure]. Author. Retrieved April 18, 2017, from http://pulse.easternhealth.ca/Pages/ImageLoader.aspx?ResourceID=4658

● Edmond, M. (2017a). Antibiotics: There is no fee lunch. [Online image]. Retrieved July 14, 2016 from http://haicontroversies.blogspot.ca/2017/06/antibiotics-theres-no-free-lunch.html

● Edmond, M. (2017b). Hand hygiene compliance and barriers in ICU Nurses. [Online image]. Retrieved July 14, 2016 from https://1.bp.blogspot.com/-

mvNRFqfTrD8/WSN08ciuQ0I/AAAAAAAAB24/eHg_KkQAkIsuUevar4yBh0uQPdvGHYT5wCLcB/s1600/HH%2Bbarriers%2BVisualAbstract.jpg

● Edwards, R., Drumright, L. N., Kiernan, M., & Holmes, A. (2011). Covering more territory to fight resistance: considering nurses’ role in antimicrobial stewardship. Journal of infection prevention, 12(1), 6-10. doi: 10.1177/1757177410389627

● Ellen, M. E., Hughes, F., Shach, R., & Shamian, J. (2017). How nurses can contribute to combating antimicrobial resistance in practice, research and global policy. International Jounral of Nursing Studies, Retrieved from:

doi:https://doi.org/10.1016/j.ijnurstu.2017.02.023

● Gillespie, E., Rodrigues, A., Wright, L., Williams, N., & Stuart, R. L. (2013). Improving antibiotic stewardship by involving nurses. American journal of infection control, 41(4), 365-367.

● Kurtz, S. L. (2017). Identification of low, high, and super gelers and barriers to hand hygiene among intensive care unit nurses. American Journal of Infection Control, 45(8), 839–843. doi:10.1016/j.ajic.2017.04.00

● Ladenheim, D., Rosembert, D., Hallam, C., & Micallef, C. (2013). Antimicrobial stewardship: The role of the nurse. Nursing Standard (through 2013), 28(6), 46.

● Llewelyn, M. J., Fitzpatrick, J. M., Darwin, E., Gorton, C., Paul, J., Peto, T. E., Yardley, L., Hopkins, S., & Walker, A. S. (2017). The antibiotic course has had its day. BMJ, 358, j3418.

● Longitude Prize. (2014). 10 Most dangerous antibiotic-resistant bacteria [Online image]. Retrieved September 2, 2017 from https://longitudeprize.org/blog-post/10-most-dangerous-antibiotic-resistant-bacteria

● Longitude Prize. (2015, January, 15). How bacteria resist antibiotics [Video file]. Retrieved from https://youtu.be/tK6yc-0kvVo

● Manning, M. (2016). Anitbiotic stewardship for staff nurses. American Nurse Today. 11(5), 12-14.

● Manning, M. L., & Giannuzzi, D. (2015). Keeping Patients Safe: Antibiotic Resistance and the Role of Nurse Executives in Antibiotic Stewardship. JONA: The Journal of Nursing Administration, 45(2), 67-69.

● Manning, M. L., Pfeiffer, J., & Larson, E. L. (2016). Combating antibiotic resistance: The role of nursing in antibiotic stewardship. American journal of infection control, 44(12), 1454-1457.

● McSpedon, C. (2017, August, 2). Antibiotic stewardship: Inherent to good nursing practice. Retrieved from https://ajnoffthecharts.com/antibiotic-stewardship-inherent-to-good-nursing-practice/

● Mostaghim, M., Snelling, T., McMullan, B., Konecny, P., Bond, S., Adhikari, S., Chubaty, A., Lovell, C., & Bajorek, B. (2017). Nurses are underutilised in antimicrobial stewardship–Results of a multisite survey in paediatric and adult hospitals.

Infection, Disease & Health, 22, 57-64.

● O'connor, N. (2017). Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow. AJN The American Journal of Nursing, 117(9), 47-49. doi: 10.1097/01.NAJ.0000524545.43320.c5

● Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The critical role of the staff nurse in antimicrobial stewardship—unrecognized, but already there. Clinical Infectious Diseases, 62(1), 84-89. doi:10.1093/cid/civ697

● Olans, R. D., Nicholas, P. K., Hanley, D., & DeMaria, A. (2015). Defining a role for nursing education in staff nurse participation in antimicrobial stewardship. The Journal of Continuing Education in Nursing, 46(7), 318-321.

doi:http://dx.doi.org/10.3928/00220124-20150619-03

● Olans, R. D., Olans, R. N., & Witt, D. J. (2017). Good Nursing Is Good Antibiotic Stewardship. AJN The American Journal of Nursing, 117(8), 58-63.

● Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The critical role of the staff nurse in antimicrobial stewardship—unrecognized, but already there. Clinical Infectious Diseases, 62(1), 84-89. doi:10.1093/cid/civ697

● Peate, I. (2015). Antimicrobial resistance: the nurse’s essential role. British Journal Of Nursing, 24(1), 5. doi:10.12968/bjon.2015.24.1.5

● Quality of Care NL. (2017a). Antibiotics – No amount poster [Online image]. Retrieved September 2, 2017, from http://qualityofcarenl.ca/wp-content/uploads/2017/01/CWNL-Antibiotics-Poster-V1-2.0.pdf

● Quality of Care NL. (2017b). Antibiotics – The right match poster [Online image]. Retrieved September 2, 2017, from http://qualityofcarenl.ca/wp-content/uploads/2016/09/CW_subcampaign_antibiotics.pdf

● Quality of Care NL. (2017c). Viral infection scrip pad [Online image]. Retrieved September 2, 2017, from http://qualityofcarenl.ca/wp-content/uploads/2017/01/CW_prescription_pad_print.pdf

● Tamma, P. D., Avdic, E., Li, D. X., Dzintars, K., & Cosgrove, S. E. (2017). Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA Internal Medicine, 177(9), 1308-1315.

● The Ottawa Hospital. (2015). Parenteral drug therapy manual (36th ed.). Ottawa,ON: Author.

● Walker, C. (2015). Procalcitonin-guided antibiotic therapy duration in critically ill adults. AACN Advanced Critical Care, 26(2), 99-106.

● Wentzel, J., van Velsen, L., van Limburg, M., de Jong, N., Karreman, J., & Hendrix, R. (2014). Participatory eHealth development to support nurses in antimicrobial stewardship. BMC medical informatics and decision making, 14(1), 45.

References