A Multidisciplinary Approach to Incorporate Bedside Nurses into Antimicrobial Stewardship and Infection Prevention David R. Ha, PharmD, BCIDP; Mary Bette Forte, MSN-Ed, RN; Rita D. Olans, DNP, CPNP-PC, APRN-BC; Kelsey OYong, MPH; Richard N. Olans, MD, FIDSA; Daniel P. Gluckstein, MD; Ravina Kullar, PharmD, MPH, FIDSA; Mamta Desai, BS, CLS, MBA, CIC; Nora Catipon, RN, MSN, GNP-BC; Vickie Ancheta, RN; Donna Lira, RN, CIC; Yesenia Khattak, CIC; Jessica Legge, RN; Kim B. Nguyen, PharmD; Sarah Chan, PharmD; John Mourani, MD; James A. McKinnell, MD Background: Antimicrobial stewardship programs exist to promote appropriate antimicrobial use. The Joint Commission has reported that although many US hospitals have implemented basic components of antimicrobial stewardship programs, there now exists a need for innovative, multidisciplinary approaches, including involving frontline clinicians such as bedside nurses. Methods: A retrospective evaluation of bedside nurse–driven antimicrobial stewardship and infection prevention rounds was conducted on a 31-bed telemetry unit of a community regional medical center. Rounds were managed by a nurse coordinator and attended by an infectious diseases pharmacist, an infection preventionist, and a nurse practitioner. Primary outcome mea- sures were antimicrobial and acid suppressant medication and invasive catheter use. Results: In the 12-month intervention period the nurse-driven rounds team reviewed of a total of 472 antimicrobial medica- tion, 480 acid suppressant medication, 321 urinary catheter, and 61 central venous catheter therapies over 867 total patient en- counters. Compared with the 12-month preintervention period, significant reductions in unit antimicrobial use (791.2 vs. 697.1 days of therapy per 1,000 patient-days; p = 0.03), acid suppressant medication use (708.1 vs. 372.4 days of therapy per 1,000 patient-days; p = 0.0001), and urinary catheter use (0.3 vs. 0.2 catheter-days per patient-day; p = 0.002) were ob- served. Conclusion: This study demonstrates successful engagement of bedside nurses in antimicrobial stewardship and infection pre- vention activities and a measurable impact on meaningful outcomes. More studies of strategies to integrate bedside nurses in antimicrobial stewardship are needed. A ntimicrobial resistance (AMR) is one of the greatest threats to global public health. Modeling suggests that from the current 700,000 deaths per year, deaths attributed to drug-resistant infections by 2050 will exceed 10 million annually, costing the global economy up to $100 trillion between 2015 and 2050. 1 Antimicrobial stewardship programs (ASPs) have been shown to improve patient out- comes and appropriate antibiotic use, while stabilizing or re- ducing AMR. 2 To address increasing rates of AMR, The Joint Commission issued a new Medication Management (MM) standard on antimicrobial stewardship (AMS): MM.09.01.01. This standard, effective January 1, 2017, consists of eight elements of performance and was designed around the core elements of ASPs recommended by the Centers for Disease Control and Prevention (CDC). 3,4 Nine months after enactment of MM.09.01.01, only 34 of 779 (4.4%) hospitals surveyed were cited for deficiencies in their ASPs. Although this suggests that basic ASP compo- nents have been widely adopted, it is now imperative that in- stitutions take the next steps in the continued progression of AMS, maximizing their effectiveness using existing resources. 4 A recent survey of leading ASPs suggests that a multidisciplinary approach, with AMS activities incorpo- rated into the routine duties of direct patient care staff, offers advantages over the traditional model in which AMS is per- formed only by infectious diseases (ID) physicians and pharmacists. 5 Others have also advocated for this inclusive team effort approach in AMS. 4,6,7 A multidisciplinary, interprofessional approach in ASPs has been espoused by the CDC. 3 Physicians and pharma- cists, as well as infection preventionists (IPs), microbiologists, and administrators, have been traditionally recognized as core members of ASPs. 8 More recently, bedside nurses have been endorsed by a variety of organizations. including the CDC, the American Nurses Association, and the National Quality Forum, as contributors with potential to enhance antimicrobial stewardship efforts due to their integral role in the antimicrobial use process. 3,9,10 However, literature 1553-7250/$-see front matter © 2019 Elsevier Inc. All rights reserved. All rights reserved. https://doi.org/10.1016/j.jcjq.2019.03.003 The Joint Commission Journal on Quality and Patient Safety xxxx; xxx:xxx–xxx