159 - A Novel Framework to Guide Antibiotic Stewardship Nursing Practice

Background: In 2017, the International Council of Nurses - a federation of more than 130 national nurses associations, representing the more than 20 million nurses worldwide - issued a statement supporting the position that nurses “play a central role in patient care and interdisciplinary communication and, as such, are in a key position to contribute to reducing antimicrobial resistance and critical for the function of antimicrobial stewardship (AS) programs.” Evidence suggests that frontline nurses are enthusiastic to participate in AS activities but lack context and a non-antibiotic prescriber frame of reference.Antibiotic Stewardship Nursing Practice: The SCAN-P Framework®


Methods: Drawing from a review of the antibiotic, environmental, and social sciences stewardship literature and interviews with AS thought leaders, we developed a framework to provide context and to guide AS nursing practice and education. Over a six month period, the framework was vetted with over 30 nurse and non-nurse clinicians and critiqued by frontline nurses engaged in AS patient care activities. The framework went through more than ten iterations, resulting in the SCANP framework (shown in Figure).

Results: The novel SCANP Framework consists of three concentric circles, sharing a common core to prevent patient harm and optimize antibiotic use. The outer circle - S - represents scope and standards of nursing practice and nursing code of ethics. Nursing practice is guided by individual country’s standards and codes. The second ring - C - culture and context represents organizational culture and local-level social/behavioral context. The extent to which nurses can successfully engage in AS with their interdisciplinary colleagues is highly dependent on how nursing is positioned within the organization. The third ring - ANP - represents current and emerging AS Nursing Practices that support the safe and responsible use of antibiotics. 

Conclusion: Recommendations to expand AS programs to include nurses have generated national and international support. But nurse engagement in AS has received limited contextual  attention. To fill the gap, we created a practical, globally applicable AS organizing framework to guide nurses, and leaders charged with nursing development and education, foster interdisciplinary dialogue on advancing AS endeavors.