Nurses are part of the Antimicrobial Stewardship Team
Nurses are part of the Antimicrobial Stewardship Team
Active engagement of nurses in antimicrobial stewardship activities is long-overdue. We can all appreciate the nursing presence in management of antimicrobials in different clinical settings, however there is little to no evidence that supports nurses as antimicrobial stewards. This is partly due to barriers, and knowledge gaps that currently exist in nursing practice. We have created nursing resources to help address some of the knowledge gaps that currently exist.
Active engagement of nurses in antimicrobial stewardship activities is long-overdue. We can all appreciate the nursing presence in management of antimicrobials in different clinical settings, however there is little to no evidence that supports nurses as antimicrobial stewards. This is partly due to barriers, and knowledge gaps that currently exist in nursing practice. We have created nursing resources to help address some of the knowledge gaps that currently exist.
Extended Infusion Beta-lactams for Pharmacists
Using antimicrobials that fit the PK/PD targets we're aiming for. Let's get our patients the most appropriate therapy we can for infection.
Why are we doing this?
The
Time above the minimum inhibitory concentration (MIC) is the most important factor for effectiveness of beta-lactam antibiotics. The longer the drug concentration is above the MIC, the better bacterial killing effect. With rising antimicrobial resistance, optimizing the effectiveness of antibiotics we have available in Canada is critical.
What's new?
With the new process, every patient will get a first dose of either piperacillin/tazobactam or meropenem over 30 minutes
No big change there.
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The two big changes:
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the 2nd dose will be given earlier*
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2nd and subsequent doses will be given over 3 hours
Note: Timeline may differ in setting of renal dysfunction.
See dosing tables below for complete information
What do I do?
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If you are seeing/verifying orders for a newly admitted patients, check the ED MAR to see if either meropenem or piperacillin/tazobactam has been given, and when. Reschedule subsequent doses accordingly.
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Extended infusions may not be forever. Reassess microbiology and the need for antimicrobials at 48-72 hours. Stop, change drug or duration of infusion based on the clinical scenario. See the pharmacist education summary for more information.
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If nurses have challenges with line access, drug compatibility, you may need to change back to a 30-minute infusion. See the pharmacist education summary for more information.
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To change to 30-minute infusions, cancel/reorder in Powerchart, remove the MD comment "over 3 hours", and change the infusion time to 30-minutes. ​
For more information, check out the files below:​​
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​Have questions? Call or email us at antimicrobial.stewardship@sinaihealth.ca
Meropenem Dosing in Renal Dysfunction
