Inpatient Antimicrobial Stewardship - Registered Nurse

Briefly describe your daily antimicrobial stewardship practices 

Our daily antimicrobial stewardship practices start from the moment we begin our bedside handoff report. During our patient handoff, the RNs check that all central line dressings are within date and are clean, dry, and intact. As an antimicrobial steward, it is important to make sure that the benefits of treatment outweigh the risk of infection. During our multidisciplinary rounds we question the need for continuing any line that poses an infection risk, such as central lines and indwelling catheters. Any time a central line blood draw is ordered, we rule out other sources of infection first in order to rule out possible line contamination. We also make sure all of our patients with central lines receive daily chlorhexidine gluconate (CHG) treatments with a linen change.

What stewardship initiative or antibiotic awareness effort are you most proud of that you have participated in or led?

I would say that the antibiotic stewardship awareness effort I am most proud of participating in is the urine culture algorithm. The urine algorithm has step by step questions that the nurses answer to help determine if a urine culture is needed (ex: does the patient have any signs/symptoms). I remember when our unit first piloted utilizing the algorithm to determine if a urine culture specimen should be collected. We had to work collaboratively with the MDs to ensure we we’re following the urine culture algorithm. Now our nurses are empowered to verify the necessity of urine cultures.

What does “Being Antibiotics Aware” mean to you?

To me, “Being Antibiotics Aware” means that we as RNs understand the indication for our patients to be on antibiotics and how important it is to use antibiotics judiciously.

What is one pearl you have for all clinicians to help them be antibiotic stewards?

I would want to share with all clinicians to not be afraid to question the necessity of antibiotic usage. Antibiotic resistance is a serious concern for the treatment of infections with the rise of antibiotic resistant organisms. We do not want to be in a situation where the antibiotics we use to save lives are no longer effective. Antibiotic stewardship is truly a collaborative effort.

Brooke Kafami, BSN, RN

Lead Clinical Nurse

Hospitalist Unit, Meyer 8

Johns Hopkins Hospital