Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2018/06/stewardship-resistance-scan-jun-15-2018
Stewardship / Resistance Scan for Jun 15, 2018
Nurses' role in stewardship; Antibiotics for nursing home residents
Filed Under:
Antimicrobial Stewardship
[h=3]Study finds nurses are overlooked in stewardship programs[/h] Research presented at the 45th annual conference of the Association for Professionals in Infection Control (APIC) suggests that nurses should play a bigger role in antimicrobial stewardship programs (ASPs).
The research, conducted at Jefferson Health (a regional health system in New Jersey and Pennsylvania), aimed to examine how the role of nursing in the system's ASP could be strengthened. Nursing buy-in was achieved by opening up participation in the ASP at three of Jefferson Health's New Jersey hospitals to nursing leadership, educators, performance improvement, and infection control. In addition, a computer-based learning module, with materials written in "nurse speak," was shared across the three hospitals.
To gauge comprehension of stewardship principles, nurses at the hospitals were given a 10-question baseline-assessment quiz on antibiotic use. The results showed that more intensive care unit (ICU) nurses recognized how to interpret antibiotic susceptibility results than non-ICU nurses (92.3% vs. 87.6%), and more ICU nurses knew how to interpret non-susceptibility results as well (82.7% vs. 78.6%). Overall, most nurses (93.8%) incorporated microbiology results during sign-out reporting. But only 50% of clinical nurses checked susceptibility results of cultures prior to administering antibiotics. If cultures showed resistance, only 65.1% of clinical nurses notified the physician.
"Our findings show that nurses have been overlooked and under-utilized in ASPs," Jefferson Health - New Jersey Infection Control Officer Cindy Hou, DO, the study's lead author, said in an APIC press release. "Changing the culture and empowering nurses to speak up about antimicrobial stewardship leads to closer team coordination and cross-discipline collaboration, which ultimately saves lives."
Jun 13 APIC 2018 abstract (search for ASR-46)
Jun 13 APIC press release
[h=3]Study highlights antibiotic prescribing outside nursing homes[/h] A study yesterday in Antimicrobial Resistance and Infection Control found that 13% of antibiotic prescriptions for nursing home residents were initiated in settings outside the nursing home, and that inappropriate use was higher in these settings.
For the study, researchers from the University of Wisconsin-Madison conducted a cross-sectional, multi-center investigation of five nursing homes in southern Wisconsin. The aim of the study was to characterize antibiotic therapy in the five nursing homes and compare the appropriateness based on the setting where the prescription was initiated.
The investigators identified antibiotic prescribing events from nursing home facility records, looking specifically at antibiotics prescribed for suspected lower respiratory infections, skin and soft-tissue infections, and urinary tract infections (UTIs) in the nursing home, in an emergency department, or at an outpatient clinic, then compared appropriateness by setting and infection type.
Among 735 antibiotic starts, 640 (87.1%) were initiated in the nursing home, 61 (8.3%) in the outpatient clinic, and 34 (4.6%) in the emergency department. UTI was the most commonly treated type of infection (49.7%). Overall, inappropriate antibiotic prescribing varied by setting: Nursing home (47.5%), emergency department (47.1%), and outpatient clinics (63.9%). Variation in inappropriate prescribing for UTI was even wider: Nursing home (55.9%), emergency department (73.3%), and outpatient clinic (80.8%). In multivariate analysis, regardless of infection type, patients who had an antibiotic initiated in an outpatient clinic had 2.98 times increased odds of inappropriate use.
Although the generalizability of the findings are limited, the authors conclude that antibiotic prescribing initiated outside of the nursing home, particularly in outpatient clinics, is an important area for additional investigation and should be considered in efforts to improve antibiotic stewardship in nursing homes.
Jun 14 Antimicrob Resist Infect Control study
Stewardship / Resistance Scan for Jun 15, 2018
Nurses' role in stewardship; Antibiotics for nursing home residents
Filed Under:
Antimicrobial Stewardship
[h=3]Study finds nurses are overlooked in stewardship programs[/h] Research presented at the 45th annual conference of the Association for Professionals in Infection Control (APIC) suggests that nurses should play a bigger role in antimicrobial stewardship programs (ASPs).
The research, conducted at Jefferson Health (a regional health system in New Jersey and Pennsylvania), aimed to examine how the role of nursing in the system's ASP could be strengthened. Nursing buy-in was achieved by opening up participation in the ASP at three of Jefferson Health's New Jersey hospitals to nursing leadership, educators, performance improvement, and infection control. In addition, a computer-based learning module, with materials written in "nurse speak," was shared across the three hospitals.
To gauge comprehension of stewardship principles, nurses at the hospitals were given a 10-question baseline-assessment quiz on antibiotic use. The results showed that more intensive care unit (ICU) nurses recognized how to interpret antibiotic susceptibility results than non-ICU nurses (92.3% vs. 87.6%), and more ICU nurses knew how to interpret non-susceptibility results as well (82.7% vs. 78.6%). Overall, most nurses (93.8%) incorporated microbiology results during sign-out reporting. But only 50% of clinical nurses checked susceptibility results of cultures prior to administering antibiotics. If cultures showed resistance, only 65.1% of clinical nurses notified the physician.
"Our findings show that nurses have been overlooked and under-utilized in ASPs," Jefferson Health - New Jersey Infection Control Officer Cindy Hou, DO, the study's lead author, said in an APIC press release. "Changing the culture and empowering nurses to speak up about antimicrobial stewardship leads to closer team coordination and cross-discipline collaboration, which ultimately saves lives."
Jun 13 APIC 2018 abstract (search for ASR-46)
Jun 13 APIC press release
[h=3]Study highlights antibiotic prescribing outside nursing homes[/h] A study yesterday in Antimicrobial Resistance and Infection Control found that 13% of antibiotic prescriptions for nursing home residents were initiated in settings outside the nursing home, and that inappropriate use was higher in these settings.
For the study, researchers from the University of Wisconsin-Madison conducted a cross-sectional, multi-center investigation of five nursing homes in southern Wisconsin. The aim of the study was to characterize antibiotic therapy in the five nursing homes and compare the appropriateness based on the setting where the prescription was initiated.
The investigators identified antibiotic prescribing events from nursing home facility records, looking specifically at antibiotics prescribed for suspected lower respiratory infections, skin and soft-tissue infections, and urinary tract infections (UTIs) in the nursing home, in an emergency department, or at an outpatient clinic, then compared appropriateness by setting and infection type.
Among 735 antibiotic starts, 640 (87.1%) were initiated in the nursing home, 61 (8.3%) in the outpatient clinic, and 34 (4.6%) in the emergency department. UTI was the most commonly treated type of infection (49.7%). Overall, inappropriate antibiotic prescribing varied by setting: Nursing home (47.5%), emergency department (47.1%), and outpatient clinics (63.9%). Variation in inappropriate prescribing for UTI was even wider: Nursing home (55.9%), emergency department (73.3%), and outpatient clinic (80.8%). In multivariate analysis, regardless of infection type, patients who had an antibiotic initiated in an outpatient clinic had 2.98 times increased odds of inappropriate use.
Although the generalizability of the findings are limited, the authors conclude that antibiotic prescribing initiated outside of the nursing home, particularly in outpatient clinics, is an important area for additional investigation and should be considered in efforts to improve antibiotic stewardship in nursing homes.
Jun 14 Antimicrob Resist Infect Control study