Rout J, Essack S, Brysiewicz P
College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
South Afr J Crit Care. 2021 Aug 24;37(2). doi: 10.7196/SAJCC.2021.v37i2.481. eCollection 2021.
Antimicrobial stewardship aims to optimise the use of antimicrobial medicines to preserve the efficacy of these medicines and to contain antimicrobial resistance where possible. Nurses constitute the largest group of healthcare workers; however, the role played by nurses within current antimicrobial stewardship strategies is largely unacknowledged despite nurses being at point-of-care at the hospital bedside.
To identify recommendations for the antimicrobial stewardship role of the bedside nurse in key global antimicrobial stewardship guidelines.
Scoping review methodology was used to systematically search published and 'grey' literature in PubMed, EBSCOhost, Google Scholar, government websites, and websites of professional societies and organisations. Search dates were 1990 to 2020. Inclusion criteria were English language antimicrobial stewardship guidelines for hospitals. Screening was conducted in two stages for title and abstract and then full text relevancy and documented according to the PRISMA Extension for Scoping Reviews.
Of the 1 824 articles that were retrieved, only 43 met the inclusion criteria. Inclusion of the bedside nurse on the antimicrobial stewardship team occurred in 13.9% (=6) of the papers. A role for the bedside nurse was recommended in antibiotic stewardship (32.5%; n=14), infection prevention and control (23.2%; =10), and administration of antimicrobial medicines (20.9%; =9) of reviewed documents. Other recommendations included the use of evidence-based antimicrobial stewardship (20.9%; =9), collaboration with other healthcare staff (11.6%; =5), facilitation of transition of care (18.6%; =8), and nurse prescription of antibiotics (4.6%; =2).
This scoping review highlights a slow but incremental increase in recognition of the role of the bedside nurse within the operational hub of antimicrobial stewardship strategies.
The present study was undertaken to fill the gap in the literature on clinical nurses' contribution in antimicrobial stewardship. The findings of the review largely demonstrate that multidisciplinary antimicrobial stewardship guidelines fail to view the bedside nurse as a contributor within antimicrobial stewardship strategies.
抗菌药物管理旨在优化抗菌药物的使用，以保持这些药物的疗效，并尽可能控制抗菌药物耐药性。护士是医护人员中最大的群体；然而，尽管护士身处医院病床边的护理点，但他们在当前抗菌药物管理策略中所起的作用在很大程度上未得到认可。
在全球主要抗菌药物管理指南中确定针对床边护士抗菌药物管理角色的建议。
采用范围综述方法，系统检索PubMed、EBSCOhost、谷歌学术、政府网站以及专业协会和组织网站上已发表的文献和“灰色”文献。检索日期为1990年至2020年。纳入标准为英文的医院抗菌药物管理指南。筛选分两个阶段进行，先筛选标题和摘要，然后筛选全文相关性，并根据范围综述的PRISMA扩展版进行记录。
在检索到的1824篇文章中，只有43篇符合纳入标准。13.9%（=6篇）的论文提到将床边护士纳入抗菌药物管理团队。在所审查的文件中，建议床边护士在抗生素管理（32.5%；n = 14）、感染预防与控制（23.2%；= 10）以及抗菌药物给药（20.9%；= 9）方面发挥作用。其他建议包括采用循证抗菌药物管理（20.9%；= 9）、与其他医护人员协作（11.6%；= 5）、促进护理过渡（18.6%；= 8）以及护士开具抗生素处方（4.6%；= 2）。
这项范围综述突出表明，在抗菌药物管理策略的运作核心中，对床边护士角色的认可虽缓慢但在逐步增加。
本研究旨在填补关于临床护士在抗菌药物管理中贡献的文献空白。综述结果在很大程度上表明，多学科抗菌药物管理指南未能将床边护士视为抗菌药物管理策略中的贡献者。
