Exploring the Key Role Nurses Play in Antimicrobial Stewardship

Transcription

1 Exploring the Key Role Nurses Play in Antimicrobial Stewardship November 7, 2017 The Association for Registered Nurses of Newfoundland & Labrador Teleconference Education Session Mat Wenger RN BSc BScN CNCC(C)

2 Disclosures None

3 Overview Antimicrobial Resistance (AMR) Antimicrobial Stewardship (AMS) Nursing Role in Antimicrobial Stewardship ICU Quick Reference Guide Fear to Undertreat or Overtreat Choosing Wisely

4 Antimicrobial Resistance

5 3 Methods Bacteria Use to Resist Antibiotics 1. Efflux Pump 2. Neutralization 3. Modification (Longitude Prize, 2015)

6 Top Ten Most Dangerous and Antibiotic Resistant Bacteria (Longitude Prize, 2014)

7 (Longitude Prize, 2014)

8 Compound Interest, 2014a)

9

10 (Edmond, 2017a)

11 Importance of Antimicrobial Stewardship Successful stewardship depends on nurses ongoing vigilance. - Olans, Olans & Witt (2017)

12 Antimicrobial Stewardship How Antimicrobial Stewardship Models Align with Nursing Activities?

13 (American Nurses Association, 2017)

14 The critical role of the staff nurse in antimicrobial stewardship unrecognized, but already there. Olans et al., Patient Admission 2. Daily Clinical Progress Monitoring 3. Patient Safety & Quality Monitoring 4. Clinical Progress/ Patient Education/ Patient Discharge

15 (Edmond, 2017b)

16 Nurses & Antimicrobial Stewardship

17 Nursing Role in Antimicrobial Stewardship 5 Key Strategies to Influence AMS In Your Practice

18 5 Key Strategies 1. Correct ABx information 2. Correct ABx route 3. Reassess ABx therapy 4. Review ABx therapy 5. Reconcile ABx

19 ICU Quick Reference Guide Quick Clinical Resource Evidence Based Collaboration Distribution

20 ICU Quick Reference Guide

21 The antibiotic course has had its day Fear to Undertreat or Overtreat Llewelyn et al. (2017) Limited evidence to suggest stopping treatment early contributes to antibiotic resistance Replace Complete Course with Exactly as Prescribed More evidence is needed to support

22 (Quality of Care NL, 2017a) (Quality of Care NL, 2017b) (Quality of Care NL, 2017c)

23 Final Thoughts Questions? What does AMS look like in your area of practice? Thank You

24 References American Nurses Association. (2017). White paper. Redefining the antibiotic stewardship team: Recommendations from the American Nurses Association/Centres for Disease Control and prevention workgroup on the role of registered nurses in hospital antibiotic stewardship practices. Retrieved from Baur, D., Gladstone, B. P., Burkert, F., Carrara, E., Foschi, F., Döbele, S., & Tacconelli, E. (2017). Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. The Lancet Infectious Diseases, 17(9), doi: /s (17) Brunning, A. (2014). An overview of antibiotics. Retrieved from Compound Interest. (2014a). Different classes of antibiotics - an overview [Online image]. Retrieved September 2, Compound Interest. (2014b). A brief overview of classes of antibiotics. Retrieved from Droege, M. E., Van Fleet, S. L., & Mueller, E. W. (2016). Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis. Critical Care Nurse, 36(2), doi: /ccn Eastern Health. (2017). Hand Hygiene[Brochure]. Author. Retrieved April 18, 2017, from Eastern Health. (2017). IPAC Information for Staff[Brochure]. Author. Retrieved April 18, 2017, from Edmond, M. (2017a). Antibiotics: There is no fee lunch. [Online image]. Retrieved July 14, 2016 from Edmond, M. (2017b). Hand hygiene compliance and barriers in ICU Nurses. [Online image]. Retrieved July 14, 2016 from mvnrfqftrd8/wsn08ciuq0i/aaaaaaaab24/ehg_kkqakisuuevar4ybh0uqpdvghyt5wclcb/s1600/hh%2bbarriers%2bvisualabstract.jpg Edwards, R., Drumright, L. N., Kiernan, M., & Holmes, A. (2011). Covering more territory to fight resistance: considering nurses role in antimicrobial stewardship. Journal of infection prevention, 12(1), doi: / Ellen, M. E., Hughes, F., Shach, R., & Shamian, J. (2017). How nurses can contribute to combating antimicrobial resistance in practice, research and global policy. International Jounral of Nursing Studies, Retrieved from: doi: Gillespie, E., Rodrigues, A., Wright, L., Williams, N., & Stuart, R. L. (2013). Improving antibiotic stewardship by involving nurses. American journal of infection control, 41(4), Kurtz, S. L. (2017). Identification of low, high, and super gelers and barriers to hand hygiene among intensive care unit nurses. American Journal of Infection Control, 45(8), doi: /j.ajic Ladenheim, D., Rosembert, D., Hallam, C., & Micallef, C. (2013). Antimicrobial stewardship: The role of the nurse. Nursing Standard (through 2013), 28(6), 46. Llewelyn, M. J., Fitzpatrick, J. M., Darwin, E., Gorton, C., Paul, J., Peto, T. E., Yardley, L., Hopkins, S., & Walker, A. S. (2017). The antibiotic course has had its day. BMJ, 358, j3418. Longitude Prize. (2014). 10 Most dangerous antibiotic-resistant bacteria [Online image]. Retrieved September 2, 2017 from Longitude Prize. (2015, January, 15). How bacteria resist antibiotics [Video file]. Retrieved from Manning, M. (2016). Anitbiotic stewardship for staff nurses. American Nurse Today. 11(5), Manning, M. L., & Giannuzzi, D. (2015). Keeping Patients Safe: Antibiotic Resistance and the Role of Nurse Executives in Antibiotic Stewardship. JONA: The Journal of Nursing Administration, 45(2), Manning, M. L., Pfeiffer, J., & Larson, E. L. (2016). Combating antibiotic resistance: The role of nursing in antibiotic stewardship. American journal of infection control, 44(12), McSpedon, C. (2017, August, 2). Antibiotic stewardship: Inherent to good nursing practice. Retrieved from Mostaghim, M., Snelling, T., McMullan, B., Konecny, P., Bond, S., Adhikari, S., Chubaty, A., Lovell, C., & Bajorek, B. (2017). Nurses are underutilised in antimicrobial stewardship Results of a multisite survey in paediatric and adult hospitals. Infection, Disease & Health, 22, O'connor, N. (2017). Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow. AJN The American Journal of Nursing, 117(9), doi: /01.NAJ c5 Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The critical role of the staff nurse in antimicrobial stewardship unrecognized, but already there. Clinical Infectious Diseases, 62(1), doi: /cid/civ697 Olans, R. D., Nicholas, P. K., Hanley, D., & DeMaria, A. (2015). Defining a role for nursing education in staff nurse participation in antimicrobial stewardship. The Journal of Continuing Education in Nursing, 46(7), doi: Olans, R. D., Olans, R. N., & Witt, D. J. (2017). Good Nursing Is Good Antibiotic Stewardship. AJN The American Journal of Nursing, 117(8), Olans, R. N., Olans, R. D., & DeMaria, A. (2016). The critical role of the staff nurse in antimicrobial stewardship unrecognized, but already there. Clinical Infectious Diseases, 62(1), doi: /cid/civ697 Peate, I. (2015). Antimicrobial resistance: the nurse s essential role. British Journal Of Nursing, 24(1), 5. doi: /bjon Quality of Care NL. (2017a). Antibiotics No amount poster [Online image]. Retrieved September 2, 2017, from Quality of Care NL. (2017b). Antibiotics The right match poster [Online image]. Retrieved September 2, 2017, from Quality of Care NL. (2017c). Viral infection scrip pad [Online image]. Retrieved September 2, 2017, from Tamma, P. D., Avdic, E., Li, D. X., Dzintars, K., & Cosgrove, S. E. (2017). Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA Internal Medicine, 177(9), The Ottawa Hospital. (2015). Parenteral drug therapy manual (36th ed.). Ottawa,ON: Author. Walker, C. (2015). Procalcitonin-guided antibiotic therapy duration in critically ill adults. AACN Advanced Critical Care, 26(2), Wentzel, J., van Velsen, L., van Limburg, M., de Jong, N., Karreman, J., & Hendrix, R. (2014). Participatory ehealth development to support nurses in antimicrobial stewardship. BMC medical informatics and decision making, 14(1), 45.