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Nurse roles in antimicrobial stewardship: lessons from public sectors models of acute care service delivery in the United Kingdom.

Castro-Sanchez, E. ORCID: 0000-0002-3351-9496, Gilchrist, M., Ahmad, R. ORCID: 0000-0002-4294-7142 , Courtenay, M., Bosanquet, J. & Holmes, A. H. (2019). Nurse roles in antimicrobial stewardship: lessons from public sectors models of acute care service delivery in the United Kingdom.. Antimicrobial Resistance & Infection Control, 8, 162. doi: 10.1186/s13756-019-0621-4


Background: Health care services must engage all relevant healthcare workers, including nurses, in optimal antimicrobial use to address the global threat of drug-resistant infections. Reflecting upon the variety of antimicrobial stewardship (AMS) nursing models already implemented in the UK could facilitate policymaking and decisions in other settings about context-sensitive, pragmatic nurse roles.

Methods: We describe purposefully selected cases drawn from the UK network of public sector nurses in AMS exploring their characteristics, influence, relations with clinical and financial structures, and role content.

Results: AMS nursing has been deployed in the UK within 'vertical', 'horizontal' or 'hybrid' models. The 'vertical' model refers to a novel, often unique consultant-type role ideally suited to transform organisational practice by legitimising nurse participation in antimicrobial decisions. Such organisational improvements may not be straightforward, though, due to scalability issues. The 'horizontal' model can foster coordinated efforts to increase optimal AMS behaviours in all nurses around a narrative of patient safety and quality. Such model may be unable to address tensions between the required institutional response to sepsis and the inappropriate use of antibiotics. Finally, the 'hybrid' model would increase AMS responsibilities for all nurses whilst allocating some expanded AMS skills to existing teams of specialists such as sepsis or vascular access nurses. This model can generate economies of scale, yet it may be threatened by a lack of clarity about a nurse-relevant vision.

Conclusions: A variety of models articulating the participation of nurses in antimicrobial stewardship efforts have already been implemented in public sector organisations in the UK. The strengths and weaknesses of each model need considering before implementation in other settings and healthcare systems, including precise metrics of success and careful consideration of context-sensitive, resource dependent and pragmatic solutions.

Publication Type: Article
Additional Information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Publisher Keywords: Antimicrobial stewardship; Nursing; Service delivery; Implementation
Subjects: Q Science > QR Microbiology
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
School of Health & Psychological Sciences > Nursing
Text - Published Version
Available under License Creative Commons Attribution.

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