Nurses’ practices of intravenous antimicrobial therapy: a scoping review
- 1Department of Nursing, Zhongshan Hospital Fudan University, Shanghai, China
- 2Fudan University School of Nursing, Shanghai, China
Abstract
Objective To systematically identify, map and synthesise the available evidence on nurses’ practices throughout the intravenous antimicrobial management process within the context of antimicrobial stewardship.Design The scoping review was conducted following the Arksey and O’Malley framework and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.Search strategy A systematic search of five electronic databases (PubMed, Web of Science, Embase, CINAHL, Medline) and grey literature was performed for studies published between 2015 and 2025.Eligibility criteria Studies were included if they described or evaluated registered nurses' actual intravenous antimicrobial administration practices or experiences. Studies focusing solely on nurses’ knowledge or attitudes without practice-related outcomes, those centred on interdisciplinary interventions where nursing-specific contributions could not be isolated, purely opinion-based discursive articles without original empirical data, and studies conducted in non-acute settings (eg, home care, long-term care facilities) were excluded.Results 30 included articles identified challenges across key stages of intravenous antimicrobial management. Findings include fragile double-checking during order review; residual drug errors and non-standardised techniques during preparation; inaccuracies in administration timing and duration; omission of infusion line flushing; unsafe disposal practices and documentation inaccuracies undermining therapeutic monitoring. These practice gaps were rooted in systemic vulnerabilities such as high workload, inadequate resources and insufficient knowledge.Conclusion This review consolidates evidence demonstrating that nursing practices in intravenous antimicrobial therapy frequently deviate from recommended standards. These process-related inaccuracies predispose patients to subtherapeutic dosing which may contribute to treatment failure and antimicrobial resistance. The observed intravenous antimicrobial practice variability across settings reflects the challenges inherent in implementing standardised care protocols in diverse healthcare environments. Evaluating the impact of administration practices on infection outcomes is a potential area of future research to inform the formation of evidence-based protocols.
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BibTeX
@article{zhai2026nurses,
title = {{Nurses’ practices of intravenous antimicrobial therapy: a scoping review}},
author = {Yue Zhai and Yu Du and Xiaohua Xu and Yuxia Zhang},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-121098},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121098},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Nurses’ practices of intravenous antimicrobial therapy: a scoping review
AU - Yue Zhai
AU - Yu Du
AU - Xiaohua Xu
AU - Yuxia Zhang
PY - 2026
DA - 2026/10/23
JO - BMJ Open
DO - 10.1136/bmjopen-2026-121098
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121098
AB - Objective To systematically identify, map and synthesise the available evidence on nurses’ practices throughout the intravenous antimicrobial management process within the context of antimicrobial stewardship.Design The scoping review was conducted following the Arksey and O’Malley framework and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.Search strategy A systematic search of five electronic databases (PubMed, Web of Science, Embase, CINAHL, Medline) and grey literature was performed for studies published between 2015 and 2025.Eligibility criteria Studies were included if they described or evaluated registered nurses' actual intravenous antimicrobial administration practices or experiences. Studies focusing solely on nurses’ knowledge or attitudes without practice-related outcomes, those centred on interdisciplinary interventions where nursing-specific contributions could not be isolated, purely opinion-based discursive articles without original empirical data, and studies conducted in non-acute settings (eg, home care, long-term care facilities) were excluded.Results 30 included articles identified challenges across key stages of intravenous antimicrobial management. Findings include fragile double-checking during order review; residual drug errors and non-standardised techniques during preparation; inaccuracies in administration timing and duration; omission of infusion line flushing; unsafe disposal practices and documentation inaccuracies undermining therapeutic monitoring. These practice gaps were rooted in systemic vulnerabilities such as high workload, inadequate resources and insufficient knowledge.Conclusion This review consolidates evidence demonstrating that nursing practices in intravenous antimicrobial therapy frequently deviate from recommended standards. These process-related inaccuracies predispose patients to subtherapeutic dosing which may contribute to treatment failure and antimicrobial resistance. The observed intravenous antimicrobial practice variability across settings reflects the challenges inherent in implementing standardised care protocols in diverse healthcare environments. Evaluating the impact of administration practices on infection outcomes is a potential area of future research to inform the formation of evidence-based protocols.
SN - 2044-6055
SN - 2044-6055
ER -