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Gloria Escalona
San Jose State University, USA
Keynote: J Nurs Res Pract
This study examines the impact of an educational intervention on antimicrobial stewardship (AS) to licensed SNF nurses and is among the first, if not the first AS research, to differentiate the various types of licensed nurses. Advantage was taken of a large urban facility wanting to establish an AS program under the auspices of the nursing department and their Infection Preventions. This study received IRB approval. A mandatory educational program on AS was given over a 1-month period by the same person to all licensed nurses on all shifts, all new nurse hires, and all nurse practitioners in a large urban nursing home. The program consisted of a new clinical decision algorithm, a sheet summarizing the McGeer-Stone Infection Criteria, and true case studies. The effectiveness of the program was determined by a post-education questionnaire and a medical records review of antimicrobial orders the month prior to and the month after the education. Comparisons were made between units staffed by RNs and those by LVNs, and between units where nurse practitioners (NPs) were allowed to order medications and those where NPs were not allowed to order medications. Prior to the educational intervention participating nurses were not aware of their role in AS. After the educational intervention, all understood what AS was, the importance of their role in stewardship, and antibiotic orders significantly decreased in those units staffed by LVNs and where NPs were authorized to order medications. Stewardship efforts in SNFs: should involve all licensed nurses, should enforce the McGeer-Stone Infection Criteria, and can be effective when applied at point of care, i.e., in the SNF nursing department, implemented by the bedside nurse with oversight by the facility Infection Preventions. The various categories of nurses in long term care facilities should be differentiated in both research practices.
Recent Publications :
1. Corazzini, K.N., McCollall, E.S., Day, L., Anderson, R.A., Mueller, C., Vogelsmeier, A., Kennerly, S., Walker, B., Flanagan, J.T., Haske- Palomine, M. (2015). Differentiating scopes of practice in nursing homes: Collaborating for care. Journal of Nursing Regulation, 6(1), 43-49
2. McGilton, K.S., Bowers, B.J., Heath, H., Shannon, K., Dellefield, M.E., Prentice, D., …Mueller, D.A. (2016, February 1). Recommendations from the international consortium on professional nursing practice in long-term care homes. Journal of the American Medical Directors Association, 17(2), 99-103. http://dx.doi.org/10.1016/j.jamda.2015.11.001
3. Olson, B., Stone, N.D., & Chinn, R. (2017, May 3). Antimicrobial stewardship in long term care facilities. PowerPoint presentation at the Infectious Disease Association of California (IDAC) and California Department of Public Health (CDPH) annual conference on practical antimicrobial stewardship: Implementation and Expansion in Healthcare Facilities, at the Doubletree Hotel SFO in Burlingame, CA
4. Scales, K., Zimmerman, S., Reed, D., Beeber, A.S., Kistler, C.E., Preisser, J.S., Sloane, P.D. (2017). Nurse and medical provider perspectives on antibiotic stewardship in nursing homes. Journal of the American Geriatrics Society, 65(), 165–171. DOI: 10.1111/ jgs.14504
5. Stone, N.D., Ashraf, M.S., Calder, J., Crnich, C.J., Crossley, K., Drinka, P.J., …Bradley, S.F. (2012). Surveillance definitions of infections in long-term care facilities: Revisiting the McGeer criteria. Infection Control and Hospital Epidemiology, 33(10), 965-977.
Escalona has had over 45 years nursing experience and spent the past 20 years working with long term care facilities as an educator and infection control consultant. For the past 7 years she has been in private practice as a consultant, teacher, and mobile foot care nurse serving the elderly in their home or facility, and teaching foot care nursing. She volunteers at several shelters and community centers providing foot and wound care to low income and unhoused populations. A popular speaker she continues to strongly advocate appropriate and evidence-based use of antimicrobials as well as appropriate health care for the unhoused and geriatric populations.
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