Exploring the Role of Nurses as Antimicrobial Stewards

Tuesday, 31 October 2017: 8:00 AM

Junel Amarado Padigos, BScN, MHSc (Hons)
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Anecita Gigi Lim, PhD
School of Nursing, The University of Auckland, Auckland, New Zealand
Stephen Robert Ritchie, PhD, MBChB
Infectious Diseases, Auckland City Hospital, Auckland, New Zealand

Purpose: Antimicrobial stewardship or safe antimicrobial management refers to a multidisciplinary approach to combat the growing problem of antimicrobial resistance associated with antibiotic overprescribing (Infectious Diseases Society of America, 2015; World Health Organization, 2015). The role of registered nurses in AMS is not well understood. The purpose of this study is to investigate nurses’ knowledge of antibiotics, antimicrobial resistance, antimicrobial stewardship and their views and perception of their potential roles as antimicrobial stewards.

Methods: A descriptive, cross-sectional quantitative survey was used in the study designed for registered nurses in the greater Auckland area of New Zealand. Questions were loaded in Qualtrics (https://www.qualtrics.com; Provo, Utah, USA), an online survey tool. Data are analyzed using descriptive and inferential statistics using Qualtrics and IBM® SPSS® Statistics version 23. Statistical significance was established at P≤0.05.

Results: A total of 298 respondents from diverse backgrounds completed the online survey. The median age group was 40-49 years old. More than half (161/298, 54%) of the respondents had higher level of qualifications in the form of postgraduate degrees. The majority felt they had “average” knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship, and a small minority (<5%) felt they had excellent knowledge. Knowledge was lowest regarding AMS – 146/298 (49%) reported “below average” or “poor” knowledge. Lack of knowledge was identified as the most challenging factor in integrating antimicrobial stewardship in clinical practice. About 84% had not heard of antimicrobial stewardship being implemented in the workplace despite its presence in major district health boards. The majority implied that educating patients on safe antibiotic use (292/298, 98%) and ensuring that antibiotics are initiated and administered at the correct time (289/298, 97%) are significant roles that nurses must play in antimicrobial stewardship. Younger and less experienced nurses (means 2.19/5 and 2.21/5, respectively) had higher expectations for antibiotics to be prescribed by their doctor for the common cold or influenza compared to older (mean 1.75/5) and more experienced nurses (mean 1.64/5), (P<0.05). An overwhelming majority suggested (N=298) that education and training of antimicrobial stewardship should be implemented in the clinical setting so that the framework can be effectively embedded in clinical practice, and 99% (294/298) proposed learning strategies to be facilitated in the workplace.

Conclusion: Nurses play an essential role in the appropriate use of antibiotics. It is therefore paramount that educational needs of nurses are addressed immediately. Sufficient knowledge related to antibiotics, antimicrobial resistance and antimicrobial stewardship are important for nurses to effectively promote the safe and judicious use of antibiotics and help thwart the growing epidemic of antimicrobial resistance.