Canadian nurses' perspectives on challenges to antimicrobial stewardship in long-term care homes

The World Health Organization recognizes antimicrobial resistance (AMR) as a top global health threat. Antimicrobial resistance-related deaths in Canada are projected to exceed 13,500 annually by 2050. In long-term care homes (LTCH), 40% to 75% of antimicrobial prescriptions are inappropriate or unnecessary. Nurses are well-positioned to lead in antimicrobial stewardship (AMS) initiatives; however, it is unclear what challenges LTCH nurses face in participating in AMS activities. This study aims to provide insights into barriers and facilitators influencing nurses' engagement in AMS within Canadian LTCHs.

A survey was developed using literature and an AMS working group assessing AMS knowledge (10 questions), confidence, barriers and facilitators. The survey targeted nurses working in Canadian LTCHs and was administered through Qualtrics online from January 20, 2023 to April 10, 2023 by distribution partners to obtain a convenience sample. Open-coding thematic analysis was used to describe quantitative data and analyze qualitative responses.

A total of 346 complete responses were recorded. The mean knowledge score was 71% (standard deviation [SD]=15%). Most respondents perceived infection prevention and control measures, and monitoring changes in the health of residents to be part of the duties of nurses within AMS. However, making recommendations about antimicrobials was the least cited nursing responsibility. This suggests a lack of clarity around the role of nurses in AMS. Barriers to AMS activities included pressure to treat and lack of meaningful interprofessional communication, while AMS education and senior management support were drivers for AMS engagement.

Education, senior-level support, and formal recognition of nurses in AMS programming represent key facilitators to effectively engage LTCH nurses in AMS best practices.