2038. Antimicrobial Stewardship (AS) Recognition, Confidence, and Organizational Factors: Multi-center Survey of Bedside Nurses

Abstract

Background There is no literature on practices nurses associated with AS processes and how patient safety culture influences nursing AS understanding and confidence. Methods This cross-sectional study used an investigator-developed survey with optional comments to describe how bedside nurses recognize and perceive their confidence performing nursing activities that support AS processes and the potential role of organization culture as an AS engagement factor. 9 hospitals ranging in size from 42 to 562 beds participated. Composite scores for practice, confidence, and safety were calculated and correlated. ANOVA with Tukey HSD post-hoc tests and non-parametric (Kruskal–Wallis) tests with Bonferroni adjusted P -values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Results A total of 558 inpatient nurses participated (response rate 13%). A significant positive association was identified between nurses' beliefs about nursing practices that contribute to the antibiotic stewardship process and their perceived confidence to perform r s = 0.454, P < 0.001. Nurses ≤5 years of experience were significantly less confident than those with >15 years of experience in: (a) assessing for a history of an adverse drug reaction (P = 0.049, P = 0.023), (b) reviewing preliminary microbiology results and comparing susceptibilities (P = 0.011, P < 0.001), and (c) notifying a provider of a wrong antibiotic dose (P = 0.011, P = 0.017). Medical/surgical nurses (P = 0.003 recognized that taking an allergy history contributes to the stewardship process significantly more than ICU respondents and were more confident, in assuring that cultures are obtained prior to antibiotic administration (P = 0.038). Free text comments indicated: organizational factors (n = 50), knowledge gap (n = 35) and poor communication (n = 11) impeded AS engagement. Conclusion This is the largest multi-site study on nursing stewardship practice that includes organizational culture as a factor influencing behavior to steward. The results identify interprofessional collaboration is needed to improve organizational factors so nurses can serve as powerful AS collaborators in this important patient safety effort. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]