Aims This paper discusses the challenges and opportunities of integrating antimicrobial stewardship within the pre-registration nursing curricula in Australia and New Zealand and proposes a practical curriculum-integrated blueprint in the implementation of this capability in alignment with evolving nursing practice. Background Antimicrobial resistance is a growing global threat requiring workforce capability towards antimicrobial optimisation. In Australia and New Zealand, national strategies and clinical standards explicitly prioritise antimicrobial stewardship and academic preparation for this role. Despite recommendations, it remains inconsistently embedded in pre-registration nursing curricula and often confined within pharmacology, rather than integrated longitudinally across the curricula. Design A discussion paper. Methods An integrative policy and literature-informed design was used to inform the discussion paper. Related peer-reviewed literature surrounding curricular focus on antimicrobial stewardship in nursing were searched using PubMed, Scopus and CINAHL Ultimate databases. The synthesis is guided by an integrative synthesis of international and national policy frameworks, surveillance data, competency frameworks, clinical standards and national learning e-tools. Results Antimicrobial stewardship can be embedded within existing learning designs, including clinical reasoning, simulations, pharmacology, infection prevention and control, microbiology/pathophysiology and other core theoretical/clinical units. While implementation is feasible, faculty time, expertise and redesign effort will be required. Antimicrobial stewardship can be operationalised as observable and assessable behaviours aligning with nationally recognised metrics. This paper presents a transferable blueprint that supports consistent implementation and accreditation alignment. Conclusion Antimicrobial stewardship is a core nursing responsibility and an ethically and clinically necessary component in pre-registration nursing curricula. Longitudinal integration is required to strengthen workforce capability against the growing threats of antimicrobial resistance.

Antimicrobial stewardship (AMS) is a systematic programme to optimise antimicrobial use and forms a key pillar of the strategies that are developed to address the global threat of antimicrobial resistance. Nurses constitute the highest number of healthcare professionals, and engagement of nursing is key to AMS. Intensive care units (ICUs) have a high-volume antimicrobial use, and yet nursing integration in AMS in the ICUs is undertheorised. Using constructivist grounded theory, we conducted 36 in-depth interviews with ICU clinicians in two Australian hospitals to explore the processes involved in navigating their roles in AMS. The resulting theory, metaphorised as 'Setting a bonfire in a newfound cave' mapped a phased process of integration reflecting the situated and variable ways nurses encounter, interpret and engage with AMS in practice. Beyond clinical insights, this study theorises AMS as jurisdictional project where nurses negotiate limits of expertise and authority, while navigating organisational and interprofessional challenges. Findings reframe AMS as a politics of care wherein players experience tensions between bureaucratic constraints and ethical obligations. The resulting theory specified the processes required to embed AMS into the core of nursing identity and practice. Situating the discretionary actions of nurses within logic and bureaucracy, we offer nuanced accounts and perspectives of how power, hierarchy and cultural norms influence and shape implementation of innovative strategies such as AMS. The theoretical insights of this study contribute to health sociology, ethics of care and implementation studies by illustrating how authority and transactions in AMS are negotiated, shared and redistributed in practice.

BACKGROUND:Central venous lines (CVLs) and arterial lines (ALs) are commonly used for patients in the intensive care units (ICUs) to facilitate the administration of medications and haemodynamic monitoring. In an ICU in Queensland, Australia (AU), saline (sodium chloride 0.9%) flush bags used for these lines were routinely changed every 24 h following organizational policy that all intravenous fluid bags are to be changed within a 24-h period. AIM:This quality improvement (QI) project aimed to evaluate current practice guided by the Plan-Do-Study-Act (PDSA) model of QI and implementation science. Benchmarking practices with other ICUs was conducted. STUDY DESIGN:A narrative literature review focused on evaluating the safe interval for changing flush solutions every 24 h was performed using EBSCO Medline, CINAHL, Cochrane Library, Embase and Google Scholar databases for citations up to November 2022. Bloodstream infection rates attributed to CVLs and/or ALs were monitored. Economic analysis was performed. End-user feedback was sought. A change of practice was implemented for a 1-year study period (March 2023 - March 2024) to extend dwell times of flushing solutions for CVLs and ALs from every 24 h to every 96 h. RESULTS:One-year post-implementation, no bloodstream infections were linked to CVLs or ALs. A simplified economic analysis was performed based on costs of 0.9% sodium chloride 500-mL fluid bags, which revealed that changing the fluid bags once every 96 h resulted in a per patient saving of AU$3.21 for any individual AL or CVL and up to AU$6.42 per patient where both an AL and CVL are in situ, based on fluid bag cost at AU$1.07 per bag. This saving excludes potential savings from reduced nursing time, infection-related costs and recycling costs. CONCLUSION:A sustainable practice change based on evidence was implemented in the local ICU. The use of the PDSA model of the QI process and the principles of implementation science strengthened the buy-in and implementation of the project. RELEVANCE TO CLINICAL PRACTICE:This practice change was examined through lenses of evidence-based practice, environmental sustainability (minimizing environmental footprint by limiting plastic bag usage), patient safety, cost minimization, and reduced nursing workload.

Background: Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied. Objective: The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia. Methods: An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p <= 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated. Results: A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement. Conclusion: The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles. (C) 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

There is an urgent and recognized need for an interprofessional collaborative approach to support global action in addressing antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) refers to systematic approaches for antimicrobial optimization within healthcare organizations. In areas with high antimicrobial utilization such as intensive care units (ICUs), specific roles for nurses in AMS are not clearly defined. This review aimed to identify and to critically evaluate primary studies that examined knowledge, perspectives and experiences of nurses associated with antimicrobial use and optimization in ICUs. A systematic search of Medline, CINAHL, PsychINFO, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science databases for primary studies published from 1st January 2000 to 20th March 2020 was performed. A convergent synthesis design was used to synthesize quantitative and qualitative data. Of the 898 studies initially screened, 26 were included. Most (18/26) studies were quantitative. All qualitative studies (6/26) were of high methodological quality. Studies where interventions were used (10/26) identified significant potential for ICU nurses to reduce antimicrobial use, time-to-antibiotic administration, and error rates. Barriers to nursing engagement included knowledge deficits in antimicrobial use, interprofessional dissonance and the culture of deference to physicians. Enhancing education, technology utilization, strong nursing leadership and robust organizational structures that support nurses were perceived as enablers to strengthen their roles in optimizing antimicrobial use. This review showed that nursing initiatives have significant potential to strengthen antimicrobial optimization in ICUs. Barriers and enablers to active engagement were identified.

BackgroundAntimicrobial stewardship (AMS) requires a multidisciplinary approach to address the global emergence of antimicrobial resistance (AMR). Nurses have potential roles to influence appropriate antibiotic use.ObjectiveThe objective of the study was to investigate knowledge of registered nurses (RNs) on antibiotics, AMR and their understanding of AMS.DesignA cross-sectional survey design was used.Participants and SettingParticipants were RNs from the greater Auckland region of New Zealand.MethodsQualtrics (Provo, Utah, USA), an online survey tool was used to collect data for a three-month period. Descriptive and inferential data was analysed using IBM® SPSS® Statistics version 23. Statistical significance was established at P ≤ 0.05.ResultsTwo hundred and ninety-eight (N = 298) respondents completed the survey. The majority rated having ‘average’ knowledge of antibiotics and generally of AMR. Lack of knowledge about AMS (211/298, 71%) was viewed as the most challenging factor in integrating AMS in clinical practice. The majority (251/298, 84%) were unaware of AMS programme being implemented in the workplace despite its presence in major district health boards in Auckland. Educating patients on safe antibiotic use (292/298, 98%) and ensuring that antibiotics are initiated and administered at the correct time (289/298, 97%) were highly viewed as fundamental nursing roles as antimicrobial stewards. Younger nurses had higher expectations for antibiotics to be prescribed by their doctor for the common cold or flu than older nurses (means 2.19/5 and 1.75/5, P = 0.001). Expectations to receive antibiotics for these viral illnesses was also higher among less experienced than the more experienced RNs (means 2.21/5 and 1.64/5, P < 0.001).ConclusionNurses play an essential role in promoting AMS practices. However, a good understanding of antibiotics, AMR and AMS is needed to effectively embed these concepts in clinical practice. Hence, addressing these educational needs is of paramount importance.