Perceptions among Pediatric Staff Nurses on Their Role and Confidence in Performing Antimicrobial Stewardship Activities

BACKGROUND: Development of comprehensive, interdisciplinary antimicrobial stewardship teams is essential. Recently, nurses are being asked to become meaningfully engaged in stewardship yet little is known about their understanding and confidence in this undertaking. METHODS: Children’s Mercy is a 354-bed freestanding, Midwestern children’s hospital which since 2008 has an ASP utilizing prospective audit and feedback with over 26,000 reviews of care led by infectious disease physicians and pharmacists. To identify the correlation between nurse perception of role and confidence in performing stewardship functions, we employed a self-developed Likert-scaled survey with optional comments. A web-based survey about the nurses’ role and confidence in 10 ASP functions was linked to 11 clinical distribution lists and was sent three times by our Chief Nursing Officer to 1098 inpatient nurses responsible for direct clinical care. Demographics were stratified by the nurses’ unit, years of experience, and years of practice at the institution. Free comments were analyzed and grouped into themes: education, hospital culture, practice, compliance, and practice recommendations. RESULTS: Responses were received from 180 (16.4%) nurses. Nurses were most confident in their role in obtaining cultures prior to antibiotics (93%), assessing an adverse drug reaction history (94%), notifying providers of dosing errors (81%), and participation in parent/patient education (91%). They were least confident in reviewing microbiology results to determine antibiotic appropriateness (38%). Identified barriers to nursing participation in ASP included: nursing not included in rounds, cultural barriers related to the nurses’ role as a steward not being well-defined, and nursing input not actively sought. The need for further education and a mechanism to integrate nurses into ASP was identified. CONCLUSION: Nurses have the requisite knowledge and skills to participate in ASP functions as a member of an interdisciplinary team. Findings confirm the need for strengthening system design that broadens the infrastructure for ASP, develops interdisciplinary collaborative practices, and establishes metrics to evaluate the nurses’ contribution to improve clinical outcomes. DISCLOSURES: All authors: No reported disclosures.