1826. Interventions to Enhance Clinical Nurse Partnership in Acute Care and Nursing Home (NH) Antibiotic Stewardship Efforts: A Scoping Review

BACKGROUND: Nurses are called upon to partner in antibiotic stewardship programs (ASPs). Yet, the nurses’ role in ASPs and measures of nurses’ contributions to ASPs are poorly defined. METHODS: Scoping review to explore (1) interventions to enhance nurses’ role in optimizing antibiotic use in the inpatient and nursing home (NH) settings and (2) measures to quantify intervention impact. We searched the PubMed, CINAHL, Embase, and Cochrane Library databases for articles published between 2005 and October 2017. We included studies that targeted clinical nurses to improve the appropriateness, timing, and duration of antibiotics. Two researchers reviewed titles, abstracts and extracted data from eligible full-texts. RESULTS: Sixteen studies met inclusion criteria (figure). Among studies, 10, 5, and 1 were conducted in the NH, inpatient or several settings, respectively. Nearly all studies (N = 15) incorporated nurses into interprofessional efforts to improve antibiotic use. Thirteen studies aimed to improve antibiotic appropriateness. Of these, six educated nurses in culturing technique and/or appropriateness; five educated nurses in antibiotic treatment guidelines; and two incorporated nurses into audit and feedback mechanisms. Six studies aimed to improve the timeliness of antibiotic administration. Of these, all included education on the importance of prompt antibiotic administration; two improved antibiotic availability and one enabled nurses to administer antibiotics before a provider’s evaluation. Two studies, both conducted in the NH, aimed to improve the duration of antibiotics by having nurses track the days of antibiotic therapy or remind prescribers to use treatment guidelines. Nonprescribing outcomes (e.g., timeliness of culture specimens and antibiotic administration, etc.) were evaluated in seven studies and significant improvements were consistently found. Prescribing outcomes (e.g., antibiotic use, appropriate antibiotic use, etc.) were evaluated in 12 studies and eight studies identified significant improvements. [Image: see text] CONCLUSION: Nurses may successfully contribute to improved antibiotic use. Further research is needed to clarify the nurses’ role in ASPs and to develop validated measures of nurses’ contributions. DISCLOSURES: All authors: No reported disclosures.