The Current and Potential Role of Nurses in Antimicrobial Stewardship in a Thai Acute Care Setting

Miss Nantanit Sutthiruk1, Professor Mari Botti1,2, Professor Julie Considine1,3, Professor Andrea Driscoll1,4, Associate Professor Ana  Hutchinson1,2, Assistant Professor Kumthorn Malathum1,5

1School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia,

2Epworth HealthCare , Melbourne , Australia,

3Eastern Health, Melbourne, Australia,

4Austin Health, Melbourne, Australia,

5Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


Antimicrobial stewardship (AMS) is important to ensure optimal antimicrobial medicine use and minimise antimicrobial resistance (AMR). A multidisciplinary approach is vital to implement AMS programs. However, not all programs include nurses. The aim of this study was to explore the current and potential role of nurses in AMS along with investigating barriers to nurses’ engagement in AMS in Thai acute care setting.


A qualitative study using a semi-structured interview guide to facilitate 15 key stakeholder interviews and three focus group discussions were conducted in a 1,000-bed university hospital in Bangkok, Thailand. Qualitative content analysis was used to identify key recurring themes by three independent researchers.


Activities recognised as part of nurses’ current role in AMS included: monitoring inappropriate antibiotic orders and adverse events; participating in antibiotic timeout and facilitating the switch from intravenous to oral therapy; providing leadership in infection prevention control, and educating consumers. Barriers to nurses taking a larger role in AMS were: lack of formal policies, high clinical workload, and lack of knowledge about antimicrobial prescribing and inadequate decision-support systems. ICU nurses and infection control practitioners were recognised as playing an active role in promoting AMS. Stakeholders identified a potential role for advanced nurse practitioners was through being a member of AMS team and AMS nurse consultant.


Participants perceived nurses to play a role in AMS as part of a routine nursing care. Formal policies and identification of AMS nurse leaders are needed to promote and develop the role of nurses in AMS.


Nantanit is a third year PhD student in the School of Nursing and Midwifery, Deakin University. Her professional background is infection control nurse and lecturer at Ramathobodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. She was awarded a PhD scholarship from her workplace to study in Australia. Nantanit’s research area is antimicrobial stewardship. The aim of her research is to explore the current and potential role of nursing in antimicrobial stewardship in acute healthcare in Thailand.

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