CHRONIC OVERUSE Talk to surgical team members when you observe the potential overuse of antibiotics.

How big of a problem is the overuse of antibiotics? The Centers for Disease Control and Prevention estimates that 20% to as much as 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate. The fallout from this chronic overuse can be significant — antibiotics are becoming less effective on the one hand, and patients are becoming more vulnerable to infections such as C. diff and MRSA on the other (since overprescribed antibiotics kill the "good" bacteria that help protect against so-called superbugs).

Where nurses fit in
Surgical nurses can help mitigate the chronic overuse of antibiotics. Here's how:

Compare clinical practice guidelines to the antibiotics being prescribed.
Review prescribed antibiotics and initiate discussions with surgical team members about clinical practice guidelines, based on what we observe when we oversee antibiotic prophylaxis for surgical patients.

Ensure cultures are performed before starting antibiotics.
This will help identify the source of the infection and help preclude the possibility that an inappropriate broad-spectrum antibiotic might negatively affect the patient.

Stay up-to-date on research findings.
Stay abreast of the latest developments so you can help your team maintain and improve efficiency without increasing the risk of infection.

Use your clinical judgment to identify barriers.
For example, we should help implement policies and procedures that account for differences among patients. Many patients are allergic to certain medications and may not fit easily into a facility's established protocol. As nurses, we need to help think through these types of common scenarios. If a patient has an allergy, what's the backup plan? Follow-up is also important. Why was a patient given an alternative antibiotic, and what were the results?

STEWARDSHIP
Does Your Facility Overprescribe Antibiotics?

Evidence is growing, says the Centers for Disease Control and Prevention, that antibiotic stewardship programs can optimize the treatment of infections and reduce adverse events associated with antibiotic use. If your facility doesn't have a stewardship program, and is looking for a place to start, the CDC has a guide called "Core Elements of Hospital Antibiotic Stewardship Programs" (osmag.net/kkRB9X). Most large academic hospitals have such programs in place, but many community hospitals and surgery centers do not. Stewardship begins with these key elements, says the CDC:

• Leadership commitment. Leaders need to buy in and be willing to dedicate all necessary resources.
• Accountability. There should be one leader, typically a physician.
• Drug expertise. A pharmacist leader should be responsible for improving antibiotic use.
• Action. You might require prescribers to document in the medical record, or during order entry, the dose, duration, and indication for all antibiotic prescriptions.
• Tracking. Monitor antibiotic prescribing and resistance patterns.
• Reporting. Regularly reported to doctors, nurses and relevant staff information on antibiotic use and resistance.
• Education. Clinicians should be educated about resistance and optimal prescribing.

— Jim Burger

Antibiotic stewardship
Ensuring that the right patients are given the right doses of the right drugs at the right times and for the right durations is only half the battle. Our involvement in this fight needs to go deeper. We should be key players in our facilities' antibiotic stewardship programs. Buy-in from leadership is crucial if antibiotic stewardship programs are to succeed.

Ultimately, the best way to protect against overuse of antibiotics is to keep infections from occurring in the first place. Since you can't always rely on antibiotics to protect our patients, focus on good practices: keeping patients warm, monitoring body temperatures and glucose levels, and of course practicing aseptic technique and hand hygiene. The combination of our quality improvement input and our commitment to focusing on basics can go a long way toward meeting the challenge. OSM