New AMS intervention for nurses: Test of change

Advocating for IV to PO abx starts April 17 for IMCU only

The below statement is from the Antimicrobial Stewardship (AMS) Committee and is notification of a regulatory requirement of nursing involvement with AMS:

The AMS team, along with Intermediate Care Unit (IMCU) Nursing leadership, are excited to inform providers about a test of change occurring on IMCU for Salem Health Medical Group patients.

To increase involvement in AMS and comply with regulatory activities, we are encouraging our medical nursing colleagues to participate in new AMS interventions. After investigation, we found that one of the most positive activities nurses could do is to advocate (suggest) for IV to PO (oral or NG tube feeding) antibiotic (abx) changes. This can decrease patient IV sites, including potential complications, help facilitate discharge and reduce the number of patients who are on IV abx therapy.

Test of change: April 17 through June 12 for IMCU only.

Process metric #1: 100% of IMCU nurses will complete the HealthStream on the AMS TOC.

Outcome metric: Days of IV therapy will decrease by 30% compared to the same dates in 2023.

In this process, nurses will review the following* daily:

1. Does the patient have one of the three following primary diagnosis: PNA, UTI or mild to moderate skin or soft tissue infection? Yes/No
   1. If no, then stop. The patient does not fit the inclusion criteria.
   2. If yes, please answer the following three questions:
      1. Does the patient have a diet? (Either PO/Tube feeds) Yes/No
      2. Is the patient taking other oral meds?  Yes/No
      3. Does the patient have stable vitals? Yes/No
      4. If yes to all three, please discuss with provider if it is possible to change from IV to PO abx during Care Progression Rounds.

*Exclusions: ID consult patients and/or extensive soft tissue infections requiring complex/advanced wound care, including surgical debridement.

Examples for how nurses can advocate to providers:

1. “The patient is now taking POs well — can this patient change from IV to oral antibiotics?
2. “The patient is now taking POs well — should we place a ‘Pharmacy Help’ order to convert IV antibiotics to PO?”
3. “The patient is tolerating tube feeding, vitals are stable and I am giving liquid meds via the NG-tube — is it possible to change to a PO antibiotic at this point?”

Thank you from your AMS, nursing leadership and clinical education teams!

• Danielle Britt, Pharm D
• G. Sierra Schneider, RN
• Marty Johnson, MD
• Buck Scholtz, MD
• Seunghyo Hong, RN
• Sheila Loomas, NM IMCU, RN
• Caitlyn Wells, RN

Questions?

Contact G. Sierra Schneider, RN, ICU and sepsis coordinator.