179 - Integrating Antibiotic Stewardship Core Elements into Nurse Residency Programs

Background:

Background: In the 2019 Centers for Disease Control and Prevention Core Elements of Hospital Antibiotic Stewardship (AS) Programs, 3 elements outline opportunities for nurse engagement:

• Leadership Commitment, securing resources to support AS endeavors, including quality/safety work


• Action, identifying new categories of nursing-based interventions


• Education, engaging nurses in patient education

Nurse Residency Programs (NRPs) enculturate newly licensed nurses (NLNs) into the profession and provide a platform for integrating NLNs into organizational initiatives, including AS.

Methods:

Methods: To determine if NRPs were an avenue to integrate core elements, nursing leaders committed to using the NRP to engage NLNs in development of unit-based AS projects. Tenured nurses mentored NLNs on evidence-based quality improvement projects with an AS nurse serving as content expert. Over 2 years, 4 cohorts, 2 in Pediatric Intensive Care Unit (PICU) and 2 in Cardiology, applied a Lean problem-solving approach (A3) to identify and implement nurse-led AS projects.

Results:

Results:  Four A3s were completed; data collection varied by group (Figure 1). Year 1, PICU developed a handoff tool, and improved frequency of nurse to nurse communication regarding the indication, duration, and day of therapy for prescribed antibiotics. Year 2, PICU developed a tool to increase parent education encounters; frequency of interactions did not change. Year 1, Cardiology implemented educational initiatives; increased awareness of nurses’ role in AS (Figure 2). Year 2, Cardiology piloted a handoff tool to promote AS; nurse communication increased. In total, 4 NLN projects were presented to leaders and clinical staff exposing 18 NLNs, 6 tenured nurses, and over 400 clinical nurses to AS. Each cohort expressed challenges integrating AS into established processes during debriefing.Figure 1: Cohort Overview
Figure 2: Example of Nursing-Driven A3


Conclusion:

Conclusions: Commitment by unit-leaders is crucial to mitigate challenges during the development of nurse-driven projects. NRPs serve as a central location to reach a large subset of nurses and shows potential for facilitating nursing-based AS interventions. Elements were integrated, through challenges remain with maintaining a standard data collection process and analysis within and across NLN cohorts.