Patient Care Services Research, Children's Mercy Hospital, Kansas City, MO.
Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO.
Am J Infect Control. 2020 Dec;48(12):1415-1421. doi: 10.1016/j.ajic.2020.07.002. Epub 2020 Jul 6.
Nurses are key in implementing antibiotic stewardship; however, standardized processes are lacking.
This feasibility study tested implementation of a nurse-driven antibiotic engagement tool (AET) that addressed antibiotic indication, duration, discontinuation, and intravenous to oral conversion. An investigator-developed survey measured nurse satisfaction, confidence, and understanding of antibiotic plan of care among 4 clinical units. Mann-Whitney U was used to compare differences between time periods. Nonparametric summary distributions assessed AET use.
Results from 121 surveys were available; 71 (36%) presurvey, 50 (24%) postsurvey. Thirteen registered nurses reported satisfaction or agreement with AET use: (1) ease (median: 4 [2.25, 4]); (2) time (median: 4 [3.5, 4.5]); (3) helped facilitate asking questions (median: 4 [3, 4]); (4) helped find antibiotic information (median: 4 [2.5, 4]); and (5) increased confidence in antibiotic discussions (median 4 [3, 4]). Planned duration of antibiotic therapy was unclear to nurses 13.9% of the time with nurses identifying duration discrepancies in 22.8% of submitted AETs.
The AET promoted interprofessional conversation. Use was higher in settings where leaders and nurse influencers were involved in stewardship promotion. Clarifying antibiotic duration is a prime area for future nursing antibiotic stewardship efforts.
护士在实施抗生素管理方面起着关键作用，但缺乏标准化流程。
本可行性研究测试了一种护士驱动的抗生素干预工具（AET）的实施情况，该工具解决了抗生素适应症、持续时间、停药和静脉到口服转换的问题。一项由研究者开发的调查评估了 4 个临床科室的护士对抗生素护理计划的满意度、信心和理解。使用 Mann-Whitney U 检验比较了两个时间段之间的差异。非参数摘要分布评估了 AET 的使用情况。
共获得 121 份调查问卷的结果，其中 71 份（36%）为预调查，50 份（24%）为后调查。13 名注册护士报告对 AET 的使用感到满意或同意：（1）易于使用（中位数：4 [2.25, 4]）；（2）节省时间（中位数：4 [3.5, 4.5]）；（3）有助于促进提问（中位数：4 [3, 4]）；（4）有助于找到抗生素信息（中位数：4 [2.5, 4]）；（5）增加了对抗生素讨论的信心（中位数 4 [3, 4]）。护士在 13.9%的时间对抗生素治疗的预期持续时间感到困惑，在提交的 AET 中，有 22.8%的护士发现了持续时间的差异。
AET 促进了专业间的对话。在参与 stewardship 推广的领导和护士影响者的环境中，AET 的使用更高。明确抗生素的持续时间是未来护士抗生素 stewardship 工作的一个重点领域。
