The researcher defined antimicrobial stewardship as a set of activities and commitments by the community or, in this case, a facility to protect the use of antimicrobials in order to ensure appropriate and optimal treatment of infections at the same time reducing the chance of resistant organisms and other adverse reactions.
The researcher utilized three methods of study: 1) an educational intervention presented to licensed nurses in October 2016; 2) a post-educational intervention Nurse Survey, which was collected in November and December 2016; and 3) a retrospective pre- and post-educational intervention medical records audit in September and November 2016 of residents reported as having an actual or potential infection. The educational intervention to licensed nurses consisted of information on SB 361, the definition of and need for antimicrobial stewardship, use of the McGeer-Stone Criteria, and an infection decision algorithm. The medical records audit measured antimicrobial use and adherence to standardized infection surveillance criteria, specifically, the McGeer-Stone Criteria.
The facility contained two nursing care areas: long-term units (LTUs) providing custodial care for elderly residents and staffed largely by Licensed Vocational Nurses (LVNs); and short-term units (STUs) providing post-acute rehabilitation for adults and staffed largely by Registered Nurses (RNs). This division enabled easy differentiation of licensed nurses and the impact of the educational intervention on adherence to infection criteria for the initiation of antimicrobial use. While there was a large increase in adherence to standardized infection criteria post-educational intervention, especially in the LVN staffed LTUs, this change was not statistically significant. However, a significant change (p=0.007) was noted in adherence to criteria by Nurse Practitioners (NPs) in the LTUs. The increase in adherence to criteria noted in the LTUs was due to a change in the prescribing behavior of the NPs and that NPs did not have prescribing capability in the STUs. NPs received the educational intervention, while other facility prescribers did not.
In conclusion, while educational efforts on antimicrobial stewardship in SNFs should include all licensed nurses and prescribers, concentrating such efforts on NPs and allowing them to practice in all areas of a SNF, may provide the greatest impact on antimicrobial stewardship programs in these facilities. It is also recommended that education of licensed nurses in antimicrobial stewardship begin in the nursing school curriculum.