Research ArticleResearchInfection ControlQuality Improvement

A nurse-led stewardship audit raised antibiotic-guideline adherence and pre-treatment culture collection in an emergency unit

Infection Control and Hospital Epidemiology (PubMed)Jul 10, 2026

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Brief summary

In a single-center quasi-experimental pre-post study, a nurse-led antimicrobial-stewardship workflow in a medical emergency unit was associated with higher antibiotic-guideline adherence (82.4% to 91.0%) and more cultures collected before antibiotics (23.0% to 40.3%).

What NurseJet pulled from the source

Emergency units make high-volume, time-sensitive antibiotic decisions but are often underrepresented in antimicrobial-stewardship programs. In this quasi-experimental pre-post study at a tertiary hospital, trained stewardship nurses first audited antimicrobial-use patterns and identified intervention targets. During the intervention phase, they reviewed antibiotic prescriptions, reinforced adherence to institutional guidance, monitored device-related practices and diagnostic use, and joined audit-and-feedback discussions with clinical teams. Guideline adherence increased from 82.4% at baseline to 91.0% during the intervention. The proportion of cultures obtained before antibiotics rose from 23.0% to 40.3%, culture positivity increased from 8.0% to 22.0%, and antibiotic de-escalation also increased, although the abstract did not provide a numerical de-escalation estimate. The authors concluded that integrating trained nurses into emergency-unit stewardship was feasible and was associated with more rational antimicrobial and diagnostic practices, but the nonrandomized design does not prove that the intervention caused the changes.

Why this matters for nurses

Nurses already see antibiotic timing, specimen collection, device care, and response to therapy unfold at the bedside, placing them in a strong position to spot stewardship gaps. This study matters because it tested a nursing role that connected those observations to real-time review and team feedback in a busy emergency setting.

Bedside takeaway

Worth knowing that a nurse-led emergency-unit stewardship audit was linked to higher guideline adherence and more cultures before antibiotics, but the single-center pre-post design cannot establish cause or patient benefit.

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Key takeaways

The intervention embedded trained stewardship nurses into prescription review, device-practice monitoring, diagnostic review, and audit-and-feedback with the emergency clinical team.
Adherence to the hospital's antibiotic guidelines increased from 82.4% before the intervention to 91.0% during it.
Cultures collected before antibiotic initiation increased from 23.0% to 40.3%, while culture positivity rose from 8.0% to 22.0%.
Antibiotic de-escalation increased, but the abstract did not report its size or patient-centered clinical outcomes.

Practice implications

For infection-prevention and emergency nurses, the findings support formal nurse participation in locally approved stewardship workflows, particularly checking whether ordered cultures are obtained before the first antibiotic when clinically feasible and escalating guideline mismatches through the designated team. The study does not justify independent antibiotic changes outside local scope, orders, or stewardship policy.

Limitations & cautions

This was a single-center, nonrandomized pre-post study, so secular changes, case mix, staffing, or clinician behavior may have contributed to the differences. The abstract does not report the number of patients or prescriptions, intervention and baseline durations, statistical uncertainty, antibiotic consumption, adverse events, resistance outcomes, or patient outcomes.
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Infection Control and Hospital Epidemiology (PubMed)

Infection Control and Hospital Epidemiology (PubMed). Evaluating a nurse-led, audit-based antimicrobial stewardship in the medical emergency unit of a tertiary level hospital.

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https://pubmed.ncbi.nlm.nih.gov/42427149/

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Archives of Academic Emergency Medicine (PubMed)Feb 1, 2026Research Article

In a single-center diagnostic accuracy study of 279 adults screened at emergency triage, manual fever checking by nurses detected fever with 100% sensitivity but lower specificity, while a non-contact forehead infrared thermometer was the more reliable way to confirm fever, especially when its cutoff was lowered to 37.5 degrees C.

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Research ArticleResearchNew Grad FriendlyAI summary · original source linked below

This single-center diagnostic accuracy study evaluated adult patients in the triage area of an emergency department in Tehran, Iran, between May and September 2023. Five emergency nurses assessed each patient with three index tests, patient-perceived fever (PPF), manual fever checking (MFC), and a non-contact frontal infrared thermometer (NCFIT), followed by a tympanic thermometer as the reference standard (fever defined as 38 degrees C or higher). Among 279 patients (mean age 52.2 years, 52% male), the tympanic thermometer identified 147 as febrile and 132 as non-febrile. Manual fever checking was the most sensitive index test at 100% (95% CI 97.5 to 100.0), with a negative likelihood ratio of 0 and accuracy of 93.9% (95% CI 89.9 to 96.0). The NCFIT had the lowest sensitivity (85.71%; 95% CI 78.9 to 90.9) but the highest specificity (98.48%; 95% CI 93.6 to 99.5) and accuracy (97.5%; 95% CI 93.1 to 99.8). When the NCFIT fever threshold was lowered to 37.5 degrees C, its sensitivity rose to 99% (95% CI 97.4 to 99.9) while specificity stayed at 98% (95% CI 94 to 99.6). The authors concluded that manual checking and patient-perceived fever could rule fever out but needed the NCFIT or tympanic thermometer to rule it in.

Key takeaways

Manual fever checking by nurses was the most sensitive method at 100% (95% CI 97.5 to 100.0), with a negative likelihood ratio of 0.
The non-contact forehead infrared thermometer had the lowest sensitivity (85.71%) but the highest specificity (98.48%) and accuracy (97.5%).
Lowering the forehead scanner's fever threshold to 37.5 degrees C raised its sensitivity to 99% while specificity held at 98%.
Manual checking and patient-perceived fever could rule out fever but required the forehead scanner or tympanic thermometer to confirm it.

Why this matters on shift

Fever screening at triage shapes early decisions about isolation, workups, and urgency, and nurses often rely on a quick touch of the skin or the patient's own report. This study may matter for nurses because it puts numbers on how well those quick checks perform, showing that a hands-on check rarely missed a real fever but tended to over-call it, so a normal touch was reassuring while a positive one deserved confirmation.

Bedside takeaway

Be aware that in one ED study, a nurse's hands-on fever check ruled fever out with 100% sensitivity but over-called it, while a non-contact forehead scanner was more reliable for confirming fever, especially at a 37.5 degrees C threshold.

Nursing implications

For emergency nurses, the findings suggest that a hands-on fever check or the patient's own sense of fever is a reasonable way to rule fever out, given the perfect sensitivity seen here, but a device reading is needed to confirm it before acting. Where a non-contact forehead thermometer is used for screening, this study found a 37.5 degrees C cutoff caught far more true fevers than the standard 38 degrees C setting.

Limitations & cautions

This was a single-center study of 279 adults in one emergency department triage area over a few months in 2023, so results may not transfer to other settings, populations, or devices. Only five nurses performed the manual checks, the tympanic thermometer served as the reference rather than a core temperature standard, and the very high manual-check sensitivity may reflect local technique and the specific patient mix.
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Citations · exact source links

Archives of Academic Emergency Medicine (PubMed). Comparing the Accuracy of Patient-Perceived Fever, Manual Fever Checking, and Non-Contact Frontal Infrared Thermometer; A Cross-sectional Study.

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Brain Sciences (PubMed)Apr 28, 2026Research Article

In a retrospective study of 728 acute-care stroke hospitalizations, nursing complexity (the number of nursing diagnoses) and nursing intensity (the number of nursing actions) differed across ischemic stroke, hemorrhagic stroke, and transient ischemic attack, with hemorrhagic stroke showing the highest intensity and transient ischemic attack the lowest.

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Research ArticleResearchStaffing & WellbeingAI summary · original source linked below

Ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA) differ in medical severity, but it has been unclear whether those differences show up in how much nursing work each requires. This retrospective study analyzed routinely collected nursing and administrative data from one acute care hospital, classifying hospitalizations as ischemic stroke, hemorrhagic stroke, or TIA using ICD-9-CM codes. Nursing complexity was measured as the number of nursing diagnoses documented within 24 hours of admission, and nursing intensity as the number of nursing actions recorded during the hospitalization, with group differences tested using ANOVA and Kruskal-Wallis tests. A total of 728 hospitalizations were included (429 ischemic strokes, 236 hemorrhagic strokes, and 63 TIAs), with 4,136 nursing diagnoses and 27,528 nursing actions recorded. Nursing diagnosis counts differed significantly (F = 5.81, P = 0.003), with TIA showing lower counts than both ischemic and hemorrhagic stroke and no significant difference between ischemic and hemorrhagic stroke. Nursing action counts also differed significantly (H = 16.73, P less than 0.001), highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA. In a sensitivity analysis standardized by length of stay, nursing intensity still differed significantly across categories (H = 12.999, P = 0.002), though the pattern differed from the cumulative counts. The authors conclude that standardized nursing data may complement medical indicators by capturing additional dimensions of patient needs and care delivery in people with stroke.

Key takeaways

The study reviewed 728 acute-care stroke hospitalizations (429 ischemic, 236 hemorrhagic, and 63 TIA), with 4,136 nursing diagnoses and 27,528 nursing actions recorded.
Nursing complexity, measured as nursing diagnoses within 24 hours of admission, differed across subtypes (F = 5.81, P = 0.003), with TIA lower than both stroke types and no significant difference between ischemic and hemorrhagic stroke.
Nursing intensity, measured as nursing actions during the stay, followed a clear gradient (H = 16.73, P less than 0.001): highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA.
Nursing intensity still differed after standardizing by length of stay (H = 12.999, P = 0.002), suggesting the gradient is not just a function of longer admissions.

Why this matters on shift

Stroke subtypes are usually described by their medical severity, but the day-to-day nursing workload they generate is less well quantified. This study may matter for neuro and stroke nurses because it uses standardized nursing language to show that hemorrhagic stroke tends to demand the most nursing actions, which can inform how acuity and assignments are weighed on the unit.

Bedside takeaway

Worth knowing that in a 728-admission records study, hemorrhagic stroke was linked to the highest bedside nursing intensity and TIA the lowest, so stroke subtype may track with how much hands-on nursing a patient needs.

Nursing implications

For neuroscience and stroke nurses, the findings reinforce that hemorrhagic stroke patients tend to carry the heaviest hands-on nursing load, while TIA patients generally require the least, which can help teams anticipate workload and advocate for appropriate assignments. Because complexity was similar between ischemic and hemorrhagic stroke while intensity was not, the number of nursing problems on admission may not, on its own, predict how much bedside work a stroke patient will need.

Limitations & cautions

This was a single-center retrospective study using routinely collected data and ICD-9-CM coding, so its findings depend on local documentation practices and may not generalize to other hospitals or nursing languages. It measured counts of nursing diagnoses and actions rather than patient outcomes, so it does not show whether higher nursing intensity changed how patients fared.
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Citations · exact source links

Brain Sciences (PubMed). Differences in Nursing Complexity and Intensity Across Stroke Subtypes: A Retrospective Study Using Standardized Nursing Language.

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BMJ Quality & Safety (PubMed)Mar 13, 2026Research Article

In a multicentre randomised controlled simulation trial with 82 nurses, independent double-checking detected more medication administration errors than single-checking overall, but the benefit was limited to experienced nurses, with no significant improvement among nurses with under five years of experience.

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Research ArticleResearchMedication SafetyAI summary · original source linked below

Double-checking medication administration is a common hospital safety practice, and independence between the two checkers is thought to be the key to its effectiveness, yet there has been no empirical evidence that independent double-checking (IDC) detects errors better than a single-nurse check. This multicentre randomised controlled simulation trial enrolled 82 nurses from two paediatric hospitals in 41 two-hour simulations, each involving two nurses who administered medication sets containing embedded errors under both single-checking and IDC conditions, with condition order and medication sets randomised. Across 1,160 dose administrations with 640 error-detection opportunities, nurses detected 72.2 percent of errors (95 percent CI 68.6 to 75.5). Overall, IDC yielded an 11 percent higher error detection rate than single-checking (adjusted incidence rate ratio 1.11, 95 percent CI 1.01 to 1.21, P = 0.02; 77.7 percent for IDC versus 66.3 percent for single checks). That benefit was limited to experienced nurses: among early career nurses (under 5 years of experience) IDC produced no significant improvement (adjusted incidence rate ratio 0.98, 95 percent CI 0.86 to 1.11, P = 0.7), while experienced nurses showed a 26 percent improvement (adjusted incidence rate ratio 1.26, 95 percent CI 1.11 to 1.44, P less than 0.001). Evidence of social loafing was seen, particularly among early career nurses, whose detection was 26.0 percent higher when single-checking than in the role of first checker in IDC, and IDC required significantly more time (mean difference 4.96 minutes per medication set, P less than 0.001). The authors conclude that, given its inconsistent benefits, resource demands, and susceptibility to social loafing, IDC may be unsuitable as a universal safety strategy, and that strengthening single-checking competence and clinical judgement may be a more effective, scalable approach.

Key takeaways

In 41 two-hour simulations, 82 nurses from two paediatric hospitals administered medication sets with embedded errors under both single-checking and independent double-checking conditions.
Overall, independent double-checking detected 11 percent more errors than single-checking (adjusted incidence rate ratio 1.11, 95 percent CI 1.01 to 1.21, P = 0.02; 77.7 percent versus 66.3 percent).
The benefit was limited to experienced nurses (26 percent improvement, P less than 0.001); among nurses with under five years of experience there was no significant improvement (P = 0.7).
Independent double-checking took about 5 minutes longer per medication set (mean difference 4.96 minutes, P less than 0.001), and social loafing lowered early career nurses' detection in the first-checker role.

Why this matters on shift

Independent double-checking is widely mandated and consumes considerable nursing time, yet its real benefit has been assumed rather than measured. This study may matter for nurses and safety leaders because it provides direct evidence that the practice helps experienced nurses catch errors but does not reliably help less experienced ones, which challenges applying it as a blanket rule.

Bedside takeaway

Be aware that in a simulation trial, independent double-checking caught more medication errors than single-checking only for experienced nurses, with no benefit for nurses under five years and signs of reduced individual vigilance when checking in pairs.

Nursing implications

For nurses and unit leaders, the findings suggest that independent double-checking is not automatically safer for every nurse or situation and can be undermined by social loafing, where a second checker relaxes their own vigilance. The results support investing in each nurse's own checking competence and clinical judgement, and reserving double-checks for the highest-risk medications, rather than treating a second signature as a guaranteed safety net.

Limitations & cautions

This was a simulation trial rather than a study of real bedside administration, so behavior with actual patients and consequences may differ, and it involved 82 nurses from two paediatric hospitals, which may limit how far the results extend to adult or other settings. Detecting deliberately embedded errors in a study scenario may not fully reflect the interruptions and workload of everyday practice.
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Citations · exact source links

BMJ Quality & Safety (PubMed). Is independent double-checking superior to single-checking in medication administration error detection? A randomised controlled simulation trial.

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Key takeaways

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More updates for this clinical area

Nurses' manual fever check caught every fever but over-called it, while a forehead scanner was better for confirming fever

Hemorrhagic stroke carried the highest bedside nursing intensity across stroke subtypes in a 728-admission records study

Independent double-checking caught more medication errors than single-checking only for experienced nurses in a simulation trial