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Introduction
Intensive care unit (ICU) antimicrobial stewardship (AMS) interventions generally do not include nurses although their role is increasingly recognised.1–4 Previous literature described inclusion of nurses and nurse-led AMS interventions outside of ICU daily bedside rounds.5 6 After using a structured quality improvement (QI) evaluation of the daily bedside rounding model of the ICU clinical team we hypothesised the addition of ‘infection’ as an entity in the ICU nurses’ structured daily report would improve interprofessional discussion of infection management.
Methods
Setting
Thirty-bed, tertiary-care, medical-surgical ICU at an academic centre with an established AMS programme.7
Design
We used the QI improvement methodology of Plan, Do, Study, Act cycle to frame this project.
Phase 1: Plan: We identified process gaps in infection management occurring during ICU interprofessional rounds.
Workflow analysis identified that the nursing daily report provided unstructured information about infection status. Infection management discussions were limited to ICU pharmacists and physicians.
Focus groups found that nurses frequently did not know the indication for prescribed antimicrobials but perceived this knowledge to be important in providing safe and effective care.
Therefore, we proposed the introduction of ‘infection’ as a separate entity in the daily nurse report to provide structure for essential information dissemination and allow routine nursing inclusion in team discussions of infection management. Using the theoretical domains framework of behaviour change, we developed an intervention focused on nurses’ capability, motivation and opportunity to participate in discussion of infection management. …