Nursing Resources

How to Optimize Antimicrobials

Antimicrobial Stewardship is selecting the right antimicrobial at the right time for our patients

Key nursing moments

Early Assessment and Treatment

  • Modified Early Warning System (MEWS) or other assessment tool

  • Implement appropriate precautions when needed

  • 2 sets of blood cultures (aerobic and anaerobic) before antibiotic administration significantly improves yield and decreases contamination

  • Do NOT send urine for culture just because it is cloudy or foul-smelling

  • Avoid swab specimens of superficial ulcers, especially of inadequately debrided wounds

  • Send C. difficile sample if suspected

  • Communicate microbiology results quickly

  • In sepsis, antibiotics should be given as soon as possible

  • Accurately chart antimicrobial administration

Clinical progress monitoring

Monitor and report response to antimicrobials

  • Rash

  • Changes in renal function

  • Some antibiotics, like vancomycin and gentamicin/tobramycin, need regular monitoring of drug levels

  • Broad spectrum antimicrobials can often be narrowed when culture results are reported

Changing IV Antibiotics to Oral Formulations

  • Ciprofloxacin, levofloxacin

  • Metronidazole

  • Azithromycin

  • Fluconazole

  • Trimethoprim-Sulfamethoxazole

  • Symptoms improving and patient is stable

  • No fever (i.e. temperature less than 38 degrees) for at least 24 hours

  • Functioning GI tract and taking other medications orally

  • Severe infection: e.g. meningitis, endocarditis, bone or deep infection, etc

  • Staphylococcal aureus or Candida bloodstream infections

  • Caution in immunocompromised patients (HIV, neutropenic, transplant patients) depending on source infection

  • GI dysfunction

Removing Sources of Infection

  • Should be removed as soon as possible

  • Catheters should not be used for management of incontinence

  • Most catheterized patients have bacteria in the urine (bacteriuria) if tested

  • Those without symptoms do not need antibiotics for bacteriuria (unless pregnant or undergoing urological procedures)

  • Do NOT send urine for culture just because it is cloudy or foul-smelling

  • Should be removed as soon as possible

Minimize Prolonged Courses of Antibiotics

  • An antibiotic time-out (reassessment) should be done at 48 - 72 hours to determine if it is still needed or if a narrower option is available

  • Remind prescribers when patients are on antibiotics for more than 7 days

Patient Education and Safety

  • Type of antimicrobial

  • Reason for antimicrobial

  • Common adverse events and when to report to healthcare workers

Terms of Use | Feedback
© Copyright 2021 Spectrum Mobile Health Inc., dba Firstline Clinical. All rights reserved.