179. Impact of a Nurse-Pharmacist Driven Antimicrobial Stewardship: Redefining the Team

Abstract

Abstract Background The Centers for Disease Control and Prevention have recognized the worldwide emergence of antimicrobial resistance. The Joint Commission mandated acute care hospitals to implement antimicrobial stewardship (AMS) programs. Core elements were developed to help hospitals achieve this goal. Core elements were updated incorporating nursing-based actions such as optimizing microbiology cultures. Methods The aim is ≥20% of ICU C. difficile, respiratory, and urine culture interventions made by the Nurse-Infectious Diseases (ID) Pharmacist AMS team will be accepted by March 4th, 2022. The ID Pharmacist engaged front line nurses in the AMS program by creating algorithms to guide nursing to appropriate culturing practices. Nurses utilized the algorithms to assess appropriateness of the cultures ordered. If deemed inappropriate, nurses contacted the ID Pharmacist and/or ordering physician to intervene. The outcome measure assessed was the percentage of interventions accepted for inappropriate C. difficile, respiratory, and/or urine cultures weekly. Process measures included time (in hours) to discontinue inappropriate cultures and the type of culture addressed. The balancing measure was the average time the Nurse/ID Pharmacist spent to assess appropriateness of ordered cultures. Results A total of 69 interventions were made by the Nurse/ID Pharmacist AMS team. Due to a high intervention acceptance rate, the target was changed from 20% to 60% at week 8. Out of the 69 interventions, 91% (n=63) were accepted and resulted in the discontinuation of the culture. The majority of accepted interventions were among urine cultures. The average time to discontinue inappropriate cultures was 2 hours and the average time the Nurse/ID Pharmacist spent to assess appropriateness of cultures was 15 minutes. Percentage of Interventions Accepted Data shown reflects the weekly percentage of accepted interventions recommended by the nurse/ID Pharmacist AMS team. Due to the high intervention acceptance rate, target was changed from 20% to 60% in week eight. Intervention Type This data reflects the number of accepted interventions for each culture type made by Nurse/ID Pharmacist AMS team resulting in the discontinuation of the inappropriate culture. Conclusion The implementation of a Nurse/ID Pharmacist AMS collaboration resulted in a high acceptance of culture interventions leading to discontinuation of inappropriate cultures. AMS nurse champions expanded SEMC’s AMS team and led to improved microbial culture practices in the ICU. Disclosures All Authors: No reported disclosures.