bedside registered nurse roles in antimicrobial stewardship 1263


72-hour review is not performed). Quantifying the impact of stewardship activities on weekends versus weekdays may help programs determine whether stewardship services should be performed 7 days per week, may help quantify the impact of stewardship service performed during the week, and can provide data when additional resources are requested.


acknowledgments


Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.


Tracelyn Freeman, BS;1,2


Greg Eschenauer, PharmD;1,2 Twisha Patel, PharmD, BCPS;1 Tejal Gandhi, MD;1,3 Lindsay Petty, MD;1,3


Carol Chenoweth, MD;1,3


Maressa Santarossa, PharmD, BCPS;1 Jerod Nagel, PharmD1


Affiliations: 1. University of Michigan Medicine, Ann Arbor, Michigan;


2. University of Michigan, College of Pharmacy, Ann Arbor, Michigan; 3. University of Michigan, Medical School, Ann Arbor, Michigan. Address correspondence to Jerod Nagel, 1111 E. Catherine St, Room 300,


Ann Arbor, MI 48109 (nageljl@umich.edu). Infect Control Hosp Epidemiol 2017;38:1262–1263 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0022. DOI: 10.1017/ice.2017.174


references


1. Core elements of hospital antibiotic stewardship programs. Center for Disease Control website. https://www.cdc.gov/ getsmart/healthcare/implementation/core-elements.html. Published 2015. Accessed March 14, 2017.


2. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.


3. Siegfried J,Merchan C, ScipioneMR, Papadopoulos J,Dabestani A, Dubrovskaya Y. Role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center. Am J Health Syst Pharm 2017;74: 417–423.


antimicrobial stewardship; however, roles and capability have not been closely assessed. In November 2015, we surveyed all Los Angeles County (LAC) acute-care hospitals (ACHs) to capture bedside RN roles and to determine the antimicrobial- related education and training hospitals provide them. An online survey was created in Google forms. InNovember


2015, we sent invitation links to all LAC ACH nurse education directors or their designees who could best speak to nurse education and competency. Responses were received by mid- January 2016. The Institutional Review Board (IRB) of the LAC Department of Public Health (DPH) designated this survey as IRB exempt. Question formats included multiple choice, select all that apply, or fill in with text. A single ques- tion with several subparts comprised the bulk of the survey. Each subpart listed a different activity or knowledge compo- nent related to antimicrobials, which respondents identified as “mandatory/required,”“optional/offered,” or “not offered” for bedside RNs in their hospital. We combined responses of “mandatory/required” and “optional/offered” to identify topics that hospitals include in bedside RN knowledge and compe- tency. Additional questions included policies related to antimicrobial administration and orders, as well as commu- nication of results. A response rate of the survey was calculated following guidelines provided by American Association for Public Opinion Research (AAPOR) Standard Definitions.1 The rate of response to this survey was 36.6%. The 34 hospitals represented in this survey comprise approximately one-third of LAC’s 93 ACHs. Most surveys were filled out by Nurse Education Directors (n=19); however, additional surveys were completed by nurse education designees such as Clinical Nurse Specialists or Bedside Nurse Educators (n=9), Directors of Nursing (DONs) or Chief Nursing Officers (n=4), or other nurse administrators (n=2). In 33 hospitals that responded (97%), bedside RNs are required to appropriately assess medication allergies prior to an antimicrobial order. In 5 hospitals (14.7%), physicians’ antimicrobial orders are entered by bedside RNs most of the time, and in 8 hospitals (23.5%), bedside RNs enter those antimicrobial orders about half the time. In 32 hospitals (94.1%), resources are provided for bedside RNs to educate inpatients about appropriate antimicrobial use, and 22 hospi- tals (64.7%) required this patient education (Table 1). In 31 hospitals (91.1%), bedside RNs are offered education on or are required to understand the relationship between antimicrobial use and antimicrobial resistance.


Bedside Registered Nurse Roles in Antimicrobial Stewardship: A Survey of Acute-Care Hospitals in Los Angeles County


To the Editor—Recent literature suggests that current activities of bedside registered nurses (RNs) can contribute to


administering and evaluating treatment


Overall, 28 hospitals (82.4%) reported that they educate or require their bedside RNs to be competent in identifying broad-spectrum antibiotics; 28 (82.4%) educate or require competency in interpreting culture/susceptibility results; 30 hospitals (88.2%) educate or require bedside RNs to be competent in monitoring therapeutic levels of antimicrobials;


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