Nurses’ Role and Understanding of the Application of Antimicrobial Stewardship Principles in Hematology Settings

Abstract

Background: Patients with hematological malignancies are highly susceptible to infection due to the disease process and/or administration of immunosuppressive therapies. Judicious use of antimicrobial therapies based on antimicrobial stewardship (AMS) principles and early recognition and response to sepsis are essential. Objective: To explore hematology nurses’ understanding of the application of AMS principles in hematology settings and their experience of using a nurse-initiated neutropenic sepsis pathway. Methods: A qualitative exploratory descriptive study using focus groups with 18 participants. Results: Three themes emerged: (1) nurses taking the lead in sepsis management; (2) timely management of neutropenic sepsis; and (3) Nurses’ knowledge of AMS principles. Associated subthemes were (1) nurse empowerment and leadership through implementation of a nurse-initiated pathway; (2) nurses’ role in supporting system processes and assessing treatment response; and (3) nurses’ knowledge of commonly used antimicrobials and the need for resources to support clinical decision-making. Conclusions: Although many participants were not familiar with the term AMS, nurses recognized their role and demonstrated leadership in early recognition and timely antimicrobial therapy. Implications for Practice: This study shows that nurse-led pathways improve patient outcomes and enable nurses to administer timely care in neutropenic sepsis. Findings also show that these pathways enable nurses to demonstrate their infection prevention and control leadership. What is Foundational: Despite knowledge gaps in nurses’ AMS, clinical pathways embedding AMS principles empowered nurses to play an active leadership role. Barriers to early treatment of neutropenic sepsis can be overcome when using dedicated pathways.