Antimicrobial Stewardship for Nursing Practice

Molly Courtenay, Enrique Castro-Sánchez, Molly Courtenay, Enrique Castro-Sánchez

• Publisher: CAB International
• Year: 2020
• ISBN:
  9781789242713
• Topic: Medicina
• Subtopic: Microbiología y parasitología médicas

Drug-resistant infections are one of the greatest threats to human health, and with resistance on the rise, appropriate antimicrobial stewardship (AMS) is more important than ever. This book, written by nurses for nurses, provides a clear and concise approach to good practice in this vital area.Exploring all aspects of AMS, this new book is underpinned by a competency framework endorsed by scientific and professional societies, including the National Institute for Health and Care Excellence (NICE). It explains the practices that ensure optimal use of antibiotics for the best clinical outcome, with both minimal toxicity to the patient and minimal impact on subsequent antimicrobial resistance. This book, the first applied directly to antimicrobial stewardship for nurses, supports standards of proficiency for registered nurses, and can therefore be used by regulators and professional bodies to inform standards of proficiency and guidance.The book covers infection prevention and control, antimicrobial resistance, diagnosis of infection and appropriate antimicrobial use, patient engagement, collaboration between professions and how to implement AMS in nursing practice. Including learning tools such as objectives, practical case studies and questions throughout, as well as lecture slides, this book is an essential read for undergraduate nursing students and specialist nurses worldwide.This book is authored by a multi-national group of experts with representation from professional associations, universities and national public health agencies, such as: - Royal College of Nursing, UK- Cardiff University, UK- University of São Paulo, Brazil- Public Health England, UK- National Centre for Antimicrobial Stewardship, Australia

Introduction

1

Molly Courtenay^*

School of Healthcare Sciences, Cardiff University, Cardiff, UK

^*E-mail: [email protected]

Antimicrobial resistant infections, i.e. infections in which micro-organisms continue to grow in the presence of antimicrobials, cause approximately 700,000 deaths, globally, each year. This figure is predicted to rise to 10 million, combined with a cumulative cost of US$100 trillion, by 2050 (HM Government, 2019). The development of resistance is influenced by the frequency of antibiotic use (Holmes et al., 2015). Antimicrobial stewardship (AMS) is described as ‘a collection of coordinated interprofessional focused strategies to optimize antibiotic use by ensuring that every patient receives an antibiotic only when it is clinically indicated and then receives the appropriate antibiotic, at the right dose, duration and route of administration’ (Manning et al., 2015). Good AMS programmes should result in the best clinical outcome for the treatment or prevention of infection, with minimal toxicity to the patient and minimal impact on subsequent resistance (Gerding, 2001).

Nursing is the largest of the healthcare professions. Nurses are identified as important to AMS efforts in both international (Centers for Disease Control (CDC) and Prevention, 2019; American Association of Nurses (AAN), 2017; European Commission (EU), 2017; European Federation of Nurses (EFN) Associations, 2017) and national policy (National Health Services Scotland, 2014; Royal College of Nursing (RCN), 2018). Nurses, worldwide, perform numerous functions that are critical to the success of AMS programmes; not only are they increasingly prescribers of antimicrobials (AAN, 2017; Courtenay et al., 2017), but they are also involved directly in a range of AMS activities (such as documentation of a medication allergy history, timely antibiotic administration, monitoring treatment and adverse events) (World Health Organisation (WHO), 2019). Furthermore, nurses are essential knowledge brokers (Broom et al., 2016) at the centre of, and facilitators of, interprofessional collaborative practice essential for optimal AMS practice (Courtenay et al., 2018). Nurses are well placed to educate the public and increase awareness of antimicrobial resistance (AMR) (RCN, 2014). For example, nurses working in general practice can communicate AMR messages to the general public. Health visitors can communicate these messages to young families, and school nurses are in an ideal position to communicate AMR messages to young people (RCN, 2014; EU, 2017; Reilly et al., 2017).

Although the education of undergraduate healthcare professional students in AMS has been identified as a key activity for the containment of AMR (WHO, 2016), evidence suggests that only two thirds of nursing programmes incorporate any AMS teaching and only 12% cover all of the recommended AMS principles (Castro-Sánchez et al., 2016).

Core AMS competencies exist for healthcare professional undergraduate education (Courtenay et al., 2018) and these competencies have been used to achieve international consensus on a framework of AMS competencies (see Appendix 1) appropriate for nurse undergraduate education programmes (Courtenay et al., 2019). This supports recommendations made by the International Council of Nurses (ICN) to include education about AMS in undergraduate nurse education programmes (ICN, 2017). The framework comprises overarching competency statements (subdivided into six domains) representing the knowledge, skills, attitudes and values that shape the judgements essential for AMS, and 63 individual competency descriptors, designed to reflect the level of experience of the learner and type of practice setting. The domains include infection prevention and control (18 competency descriptors), antimicrobials and AMR (5 competency descriptors), diagnosis of infection and use of antimicrobials (17 competency descriptors), antimicrobial prescribing practice (10 competency descriptors), person-centred care (7 competency descriptors) and interprofessional collaborative practice (6 competency descriptors). The competency framework supports standards of proficiency (Nursing and Midwifery Council (NMC), 2018), equipping newly registered nurses with the underpinning knowledge and skills required for their role in health promotion and protection and prevention of ill health.

Chapters 2–7 address each of the six domains, providing the necessary knowledge to enable students and practitioners to apply the competency descriptors in practice, no matter what their level of skill or type of practice setting/context is. Chapter 8 provides information for those leading AMS strategy with an understanding of how to implement AMS in nursing practice.

Appendix 1 – AMS Framework

DOMAIN 1: INFECTION PREVENTION AND CONTROL

COMPETENCY STATEMENT: All qualified healthcare professionals must understand the core knowledge underpinning infection prevention and control and use this knowledge appropriately to prevent the spread of infection.

Descriptors

To support antimicrobial stewardship, learners must demonstrate infection prevention and control by:

1. Describing what a micro-organism is;

2. Describing the different types of organisms that may cause infections;

3. Explaining what an antimicrobial resistant organism is;

4. Explaining the ‘Chain of Infection’;

5. Defining the components required for infection transmission, i.e. presence of an organism, route of transmission of the organism from one person to another (a host who is susceptible to infection);

6. Describing the routes of transmission of infectious organisms, i.e. contact, droplet, airborne routes;

7. Present and recognize the characteristics of a susceptible host;

8. Demonstrate an understanding of the importance of surveillance;

9. Describe how vaccines can prevent infections in susceptible persons;

10. Demonstrate the application of standard precautions in healthcare environments;

11. Apply appropriate policies/procedures and guidelines when collecting and handling specimens;

12. Apply policies, procedures and guidelines relevant to infection control when presented with infection prevention and control cases and situations;

13. Implement work practices that reduce the risk of infection (such as taking appropriate immunization or not coming to work when sick to ensure patient and other healthcare worker protection);

14. Appreciate that healthcare workers have the accountability and obligation to follow infection prevention and control protocols as part of their contract of employment;

15. Act as a role model to healthcare workers and members of the public by adhering to infection prevention and control principles;

16. Demonstrating knowledge and awareness of international/national strategies on infection prevention and control and antimicrobial resistance such as Global Action Plan for AMR and national recommendations, guidelines and legal requirements, or equivalent;

17. Understanding the role of the environment in optimal infection prevention and control practices, including hand hygiene and environmental cleaning;

18. Enabling infection prevention and control self-care for patients and families.

DOMAIN 2: ANTIMICROBIALS AND ANTIMICROBIAL RESISTANCE

COMPETENCY STATEMENT: All qualified healthcare professionals need to understand the core knowledge underpinning the concept of antimicrobial resistance and use this knowledge to help prevent antimicrobial resistance.

Descriptors

To support antimicrobial stewardship, learners must be able to:

1. Recognize the signs and symptoms of infection;

2. Discuss how inappropriate antimicrobial use (including non-adherence to treatment regime) may lead to antimicrobial resistance;

3. Identify approaches to support optimal prescribing of antimicrobials;

4. Recognize the importance of adequate specimen collection during relevant stages of antimicrobial use (i.e. prior to/during antibiotic treatment);

5. Describe how to recognize the appropriate response to antimicrobial treatment and the main signs that demonstrate antimicrobial failures.

DOMAIN 3: THE DIAGNOSIS OF INFECTION AND THE USE OF ANTIBIOTICS

COMPETENCY STATEMENT: All qualified healthcare professionals need to demonstrate knowledge in how infections are diagnosed and the appropriate use of antimicrobials, and use this knowledge appropriately to support the accurate diagnosis of infection and the appropriate use of antimicrobials.

Descriptors

To sup...