Nursing’s Role in Antibiotic Stewardship

Nursing’s Role in Antibiotic Stewardship

Last October, the CDC put out a call for clinicians interested in becoming part of a focus group that would explore the role of registered nurses in antibiotic stewardship programs in acute care hospitals. The injudicious use of antibiotics is known to contribute to the rise of antibiotic-resistant organisms like MRSA as well as to hospital-acquired infections like C. difficile. (The World Health Organization defines antimicrobial resistance as “the increasing resistance of a microorganism to an antimicrobial medicine to which it was originally sensitive.”) Infections caused by pathogens that are resistant to multiple drugs are among the hardest to treat, and are associated with prolonged hospital stays, increased costs, and higher mortality rates. According to the CDC, antibiotic resistance is a pressing public health issue, causing over two million instances of illness and 23,000 deaths annually in the U.S.

Preventing the emergence of new strains of resistant pathogens depends on antibiotic stewardship programs (ASPs), defined as efforts to optimize the use of antibiotics to ensure good outcomes while causing minimal harm to patients and public health. This optimization can include:

  • Ensuring an antibiotic is needed through culture and sensitivity testing
  • Prescribing narrow spectrum antibiotics whenever possible
  • Administering antibiotics orally rather than intravenously whenever possible
  • Using the shortest course and lowest dose of antibiotics feasible
  • Avoiding certain antibiotics in hospital settings

In the past, antibiotic stewardship programs have mainly involved physicians and pharmacists—and, more recently, infection preventionists. The current discussion about involving nurses in hospital ASPs only makes sense. Researchers have estimated that anywhere from 25 to 68 percent of antibiotic use in hospitals is inappropriate. Clearly someone needs to be paying attention. And nurses are the frontline caregivers, having the most consistent presence at the bedside and playing a key role in patient safety. It’s especially noteworthy that we seem to be shifting to a new world order, one in which nurses increasingly have opportunities to make a real difference, to offer solutions, and to contribute to patient outcomes.

In this way, this new conversation is about more than antibiotic stewardship. It’s also about evidence-based nursing practice, nursing autonomy, professional empowerment, shared decision making, and collaborative practice. Participating in interdisciplinary ASPs will increase nursing’s visibility and respect within the organization and provide nurses with another avenue to become more effective patient advocates. It will position nurses as key contributors to the collaborative care team.

There are challenges, however. Nurses currently don’t have the formal training needed to contribute to antibiotic management efforts—including most of those trained as infection preventionists. We’ll have to close this knowledge gap, and to acknowledge that the power structure in many hospitals makes it difficult for nurses to speak up and challenge a physician’s orders. Increasing nurses’ knowledge of antibiotic use and involving them in the decision making process, perhaps by including them in rounds, is likely to have a positive impact on ASP effectiveness. Even though nurses don’t prescribe, they can support or influence the decisions of other providers. For instance, in a report called the “Core Elements of Hospital Antibiotic Stewardship Programs,” the CDC suggests that nurses can ensure cultures are performed before starting antibiotics, monitor adherence to recommended guidelines, and question instances of suboptimal antibiotic therapy.

Are you up for this new challenge? When it comes to multi-disciplinary care, education is the great equalizer, the key to gaining respect across all disciplines. In its landmark report, “The Future of Nursing,” the Institute of Medicine (IOM) discussed the importance of nurses having more educational parity with other members of the health care team. Collaboration is more likely to occur when staff nurses are empowered with knowledge and have more equality with other healthcare professionals that are educated at the graduate and post-graduate level. American Sentinel University is an innovative, accredited provider of online nursing degrees.