1264 infection control & hospital epidemiology october 2017, vol. 38, no. 10


table 1. Nurse Competency and Education Series (n=34) Topic of Survey Question


Educating patients on appropriate antimicrobial use


The relationship between antimicrobial use and antimicrobial resistance Identification of broad-spectrum antimicrobials


Interpreting culture and sensitivity results from microbiology laboratory results Monitoring of therapeutic levels of antimicrobials Treatment specificity of antimicrobials Antimicrobial medication timing


Prevention of multidrug-resistant organisms Risk factors for antimicrobial-resistant organisms Knowledge of antimicrobial adverse effects


Required, No. (%)a 22 (64.7)


Mandatory/


18 (52.9) 12 (35.3) 16 (47.1) 22 (64.7) 12 (35.3) 29 (85.3) 25 (73.5) 22 (64.7) 19 (55.9)


Offered, No. (%)b 10 (29.4)


Optional/


13 (38.2) 16 (47.1) 12 (35.3) 8 (23.5) 16 (47.1) 4 (11.8) 8 (23.5) 10 (29.4) 10 (29.4)


aMandatory/Required: “If the topic is required for bedside registered nurse (RN) competency/skills labs/mandatory education.” bOptional/Offered: “If education on that particular topic is offered to bedside RNs by your facility, but not mandatory.” cNot offered: “If the education on that particular topic is not made available to bedside RNs.”


28 hospitals (82.4%) educate or require competency in antimicrobial treatment specificity. Survey respondents were asked which members of the


patient care team received critical microbiology laboratory results (as defined by the hospital): 31 hospitals (91.1%) reported that the bedside RN was notified, and in 4 (11.8%) of those hospitals, the sole notification was to the bedside RN. In a “select all that apply” question, we asked respondents to


describe how bedside RNs participate in antimicrobial stewardship. Overall, 5 hospitals (14.7%) reported no bedside RN participation in antimicrobial stewardship. In 3 hospitals (8.8%), at least 1 bedside RN is on the antimicrobial stew- ardship program (ASP) committee; however, in 19 hospitals (55.9%), nursing leadership represents them and no bedside RNs are on the ASP committee. Bedside RNs participate in quality assurance for antimicrobial treatment in 9 responding hospitals (26.5%), and in 3 hospitals (8.8%), they participate on subcommittees that promote antimicrobial stewardship knowledge on their respective units. Finally, in just 1 hospital (2.9%), bedside RNs have an antimicrobial resistance/multi- drug-resistant organisms advisory group. Literature and experience presume that bedside RNs have a


central role in entering orders, administering antimicrobials, and evaluating antimicrobial treatment2–4; however, nursing roles may be different in each hospital. With this survey, we sought to compare the differences of bedside RN engagement in antimicrobial stewardship and to identify existing opportunities within current nursing roles. Prior to ordering medications, nurses potentially influence


prescribers.5 When nurses are educated regarding anti- microbial stewardship and they understand the relationship between antimicrobial use and antimicrobial resistance, they are more likely to question antibiotic orders.6,7 The results of this survey demonstrate that bedside RNs frequently enter antimicrobial orders, and thus have at least 1 opportunity to discuss antimicrobial indications with ordering providers. By eliminating untrue allergies, bedside RNs can potentially increase medication options available to inpatients.8 Respon- dents to the survey confirmed that bedside RNs are required to appropriately assess medication allergies.


Bedside RNs have an important role in the administration


and evaluation of antimicrobial treatment, and they frequently serve as a communication hub between the patient, physician, laboratory, and pharmacy. They can initiate or support evidence-based interventions for optimal antimicrobial treat- ment, such as antimicrobial time-outs.9 Respondents to this survey reported that bedside RNs are trained to recognize broad-spectrum antibiotics, to consult culture/susceptibility results, to monitor therapeutic levels of antimicrobials, and to assess antimicrobial treatment for appropriateness. This study had limitations. The rate of response to this survey


Offered, No. (%)c 2 (5.9)


Not 3 (8.8)


6 (17.6) 6 (17.6) 4 (11.8) 6 (17.6) 1 (2.9) 1 (2.9) 2 (5.9)


5 (14.7)


was 37%(n=34). Although the survey questions were specific, a nurse education director unfamiliar with antimicrobial stewardship may have misinterpreted questions related to competency in antimicrobial administration and/or evaluation. Bedside RNs are the frontline staff who administer anti- microbials, and they access the same information that ASPs use to optimize antimicrobial treatment. By empowering bedside RNs, ASPs can potentially achieve increased com- pliance to and adherence with antimicrobial stewardship activities across all disciplines.


acknowledgments


Financial support: This survey was supported by the County of Los Angeles Department of Public Health. Potential conflicts of interest: All authors report no conflicts of interest rele- vant to this article.


Crystal D. Cadavid, RN, MSN, PHN, CMSRN, CIC; Sharon D. Sakamoto, RN, MSN/MPH, PHN; Dawn M. Terashita, MD, MPH; Benjamin Schwartz, MD


Affiliations: Department of Public Health, County of Los Angeles, Los


Angeles, California. Address correspondence to Crystal Cadavid, Healthcare Outreach Unit,


Acute Communicable Disease Control 313 N Figueroa St, Room 212, Los Angeles, CA 90012 (ccadavid@ph.lacounty.gov). PREVIOUS PRESENTATION: A preliminary summary of these results were


posted on the County of Los Angeles Department of Public Health website (http://publichealth.lacounty.gov/acd/docs/AntimicrobialsNurseSurvey.pdf).


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