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NURSES IN ANTIMICROBIAL STEWARDSHIP
Jo McEwen Advanced Nurse Practitioner
Antimicrobial Stewardship, NHS Tayside
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NURSINGWORKFORCE:
• LargestprofessionalworkforcewithinHealthcare
• Regularclinicalreviewandengagementwithpatients
• Consistentroleatpointofcareforpatientsandfamilies
• Primaryroletoadministermedicationssafelyandeffectively
• NMCdutyofcaretoensurenoharm&patientsreceivethecorrect
medicine
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Olans, Olans & De Maria, 2015 Clinical Infectious Diseases
WHERECANNURSES/MIDWIVESCONTRIBUTETOAMS?
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NOEXTRAWORKINVOLVED!
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NURSING/MIDWIFERYINFLUENCEINANTIMICROBIALSTEWARDSHIP
McEwenJ.&BurnettE.AntimicrobialStewardshipandpre-registrationstudentnurses:Evaluationofteaching.JournalofInfectionPrevention,2017.https://doi.org/10.1177/1757177417726156
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INTERNATIONALPERSPECTIVE
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CURRENT NURSING AMS INVOLVEMENT IN UK § National audit & feedback
§ Penicillin allergy review
§ Education & awareness – pre & post registration
§ Bacteraemia review – SABs & Gram -ve
§ Antimicrobial stewardship rounds
§ Bone & joint infection rounds
§ International AMS collaboration
§ Health & Social Care Integration
§ R&D
§ Policy & strategic direction
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UK PERSPECTIVE – WHAT’S TO COME
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ANTIMICROBIAL STEWARDSHIP IN NURSING
CLINICAL PRACTICE
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AMSNURSINGROLECOMMUNITYHOSPITAL
12montheducationprogrammefornurses
Mosthospitalspredominantlynurseled
GP&Pharmacyinputvariable(dailyinonewardonly)
Aims
Increasenursingknowledge
Reducenumberofinappropriateurinesamplessenttothelab
Measurables
Pre-test/post-testquestionnaire
Numberofurinesamplessenttolab
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Question Pre-testresult Post-testresult Pvalue
Iknowwhatantimicrobialstewardshipmeans 50%Agree36%Disagree14%Unsure
96%Agree4%Disagree
0.019
Ihavesufficientknowledgeofantibioticstoasktheprescriberquestionsaboutantimicrobialprescriptions
68%Agree23%Disagree9%Unsure
92%Agree8%Unsure
0.01
Iknowwhatismeantbyempiricantibiotictherapy 23%Agree54%Disagree23%Unsure
76%Agree4%Disagree20%Unsure
0.00003
UrinalysisisareliabletoolinthediagnosisofUTIinolderadultsandcatheterisedpatients
27%Agree64%Disagree9%Unsure
92%Disagree4%Agree4%Unsure
0.019
Antibioticresistanceonlyaffectsthepersonwhohasreceivedtheantibiotics
45%Agree18%Disagree41%Unsure
20%Agree76%Disagree4%Unsure
0.029
IknowwhichantibioticsareclassedashighriskintermsofpromotingresistanceorC.difficileinfection
73%Agree23%Disagree4%Unsure
92%Agree8%Unsure
0.013
Results
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Knowledgedoesnotalwaysresultinbehaviourchange
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IMPACTONPRACTICEQuestion Response
Hasthesessiononantimicrobialstewardshipbeenbeneficialforyournursingpractice? 100%Yes
Sinceattendingtheeducationalsessiononantimicrobialstewardship,Inowfeelmoreconfidentinmyroleinthemanagementofinfections.
95.24%Yes4.76%Nochange
Canyouprovideanexampleofwhereyouhaveusedtheareasofnursinginfluenceorprinciplesofantimicrobialstewardshipinclinicalpractice?Qualitativethemes
• End date antibiotic prescriptions • Urinalysis no longer used as diagnostic tool for UTI • Questioning inappropriate sample requests • Review lab results for sensitivities
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URINESAMPLES Statisticallysignificantreductioninurinesamplessenttothelabsfrommean20.9to14.9samplesper1000OBD(p=0.009)§ 29%overallreduction§ Marginalcostsaving§ Preventionofantimicrobialprescriptions
UCL
LCL
0
5
10
15
20
25
30
Sep-14
Oct-
14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-
15
Apr-
15
May-
15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-
15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-
16
Apr-
16
Urine Samples Sent for Culture from Community Hospitals 9/14 – 4/16
No.
of U
rine
Sam
ples
per
10
00 O
BD
s
Antimicrobial Stewardship Programme introduced
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UNDERGRADUATENURSINGEDUCATION
Educationintroducedtoundergraduatenursingprogramme2014
FirstSchoolofNursingtoincludeAMS
AMSeducationdeliveredin3rdyr
Blendedteachingmethods
IncorporatesallprinciplesofAMS,microbiologyandareasofnursinginfluenceinAMS
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EVALUATIONOFUNDERGRADUATENURSINGEDUCATION
Evaluation carried out 2016
Quantitative & qualitative evaluation questionnaire
10 questions and 3 statements
All 13 questions had optional free text
Survey completed by 167 students
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RESULTSKNOWLEDGE&UNDERSTANDING
15% of students aware of AMS pre-lecture rising to 79% post-lecture
“Nurses&studentsspendmosttimewith
patients&arekeyfactor
inpatienteducation”
“Students are not in
a position to
challenge a
prescriber”
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APPLICATIONTOCLINICALPRACTICE
92%believedthatnurseshaveanimportantroletoplayinAMS
71%couldidentifywheretheycouldcontributetoantimicrobial&infectionmanagement
38%felttheirpracticehadchanged
“Promote IPC with colleagues”
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RELEVANCETOPRE-REGISTRATIONPROGRAMME
84%feltthatAMSrelevanttoundergraduatenursingeducation
73%feltmoreconfidentinaskingaboutantimicrobialprescriptions
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HOPESFORTHEFUTURE-SYNERGY….
CastroSanchezEM,GilchristM,McEwenJ,SmithM,KennedyH,HolmesA.,2017,Antimicrobialstewardship:wideningthecollaborativeapproach,JournalofAntimicrobialStewardship
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@jomcewen1977