Nurse-led antibiotic stewardship intervention reduces unnecessary urine cultures
A new before-after study in The Joint Commission Journal on Quality and Patient Safety, “A Pilot Study to Evaluate the Impact of a Nurse-Driven Urine Culture Diagnostic Stewardship Intervention on Urine Cultures in the Acute Care Setting,” details the impact of a nurse-driven urine culture (UrCx) stewardship intervention for adults with and without urinary catheters, reported The Joint Commission.
Antibiotic stewardship programs (ASPs) improve patient outcomes and reduce antibiotic resistance. While recent guidance documents have outlined activities and approaches to integrate acute care nurses in antibiotic stewardship (AS) activities, few data have been published on effective ways nurses can contribute to AS efforts. Overtreatment of asymptomatic bacteriuria (ASB) is a major driver of inappropriate antibiotic use in hospitals. Working with nurses to reduce unnecessary UrCxs may improve the diagnosis of urinary tract infections (UTIs) and, indirectly, antibiotic use. The stewardship intervention was carried out in a 24-bed adult medicine unit staffed by rotating providers from a group of 27 hospitalists and 37 nurses at the Johns Hopkins Hospital, Baltimore. The intervention included:
· Education on the principles of diagnostic stewardship.
· Identification of a nurse champion to serve as liaison between nursing staff and the antibiotic stewardship program.
· Implementation of an algorithm to guide discussions with hospitalists about situations when UrCx may not be needed.
With the intervention, the mean UrCx rate per 100 patient-days decreased from 2.30 to 1.52, while without intervention it increased from 2.17 to 3.10. In addition, with the intervention, the rate of inappropriate UrCx decreased from 0.83 to 0.71. The findings support that nursing education and a clinical tool to enhance discussion on the necessity of UrCx among nurses and hospitalists are associated with a reduction in UrCx.
