Exploring the nurses' role in antibiotic stewardship: A multisite qualitative study of nurses and infection preventionists

Background: There is a growing recognition of the need to partner with nurses to promote effective antibiotic stewardship. In this study, we explored the attitudes of nurses and infection preventionists toward 5 nurse-driven antibiotic stewardship practices: 1) questioning the need for urine cultures: 2) ensuring proper culturing technique: 3) recording an accurate penicillin drug allergy history: 4) encouraging the prompt transition from intravenous (IV) to oral (PO) antibiotics: and 5) initiating an antibiotic timeout. Methods: Nine focus groups and 4 interviews with 49 clinical nurses, 5 nurse managers, and 7 infection preventionists were conducted across 2 academic pediatric and adult hospitals. Results: Nurse-driven antibiotic stewardship was perceived as an extension of the nurses' role as patient advocate. Three practices were perceived most favorably: questioning the necessity of urinary cultures, ensuring proper culturing techniques, and encouraging the prompt transition from IV to PO antibiotics. Remaining recommendations were perceived to lack relevance or to challenge traditionally held nursing responsibilities. Prescriber and family engagement were noted to assist the implementation of select recommendations. Infection preventionists welcomed the opportunity to assist in providing nurse stewardship education. Conclusions: Nurses appeared to be enthusiastic about participating in antibiotic stewardship. Efforts to engage nurses should address knowledge needs and consider the contexts in which nurse-driven antibiotic stewardship occurs. (C) 2018 Association for Professionals in Infection Control and Epidemiology. Inc. Published by Elsevier Inc. All rights reserved.