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Hamilton RA, Williams N, Ashton C, Gilani SAD, Hussain S, Jamieson C, Razaq S, Jenkins A. Nurses' attitudes, behaviours, and enablers of intravenous to oral switching (IVOS) of antibiotics: A mixed-methods survey of nursing staff in secondary care hospitals across the Midlands region of England. J Hosp Infect 2024:S0195-6701(24)00177-4. [PMID: 38782054 DOI: 10.1016/j.jhin.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Intravenous (IV) antibiotic use in secondary care in England is widespread. Timely appropriate intravenous to oral switch (IVOS) has the potential to deliver significant clinical and operational benefits. To date, antimicrobial stewardship (AMS) efforts around IVOS have not focused on the nursing staff who administer antibiotics, which represents a significant gap in AMS programmes. AIMS To determine the involvement of bedside nurses in acute trusts in the Midlands region of England in IVOS in their organisations and describe their views regarding how to improve IVOS. METHODS An anonymous self-administered mixed-methods online survey was developed and distributed to nursing staff in acute trusts via antimicrobial stewardship networks between March and May 2023. Quantitative data was analysed to describe participant demographics and behaviours, whereas barriers and enablers to IVOS were explored through thematic content analysis of responses to open-ended questions. FINDINGS 545 nursing staff responded to the survey. The majority (65.3%) routinely suggested IVOS to clinicians, despite only 50.6% being aware of local IVOS policies. One third (34.7%) did not suggest IVOS, relying on doctors, believing their patients needed IV treatment, or lacked knowledge and skills to request IVOS. Content analysis of suggestions for improving the rate of IVOS proposed three major themes (People, Process, System) and identified that education and training, improved confidence and interprofessional relationships, and prompts were important drivers. CONCLUSIONS Nursing staff suggest IVOS to other clinicians, but more education and resources are needed to enable and empower them in this role.
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Affiliation(s)
| | | | - Corrine Ashton
- Pharmacy Department, University Hospitals Leicester NHS Trust, Leicester, UK.
| | | | - Sadiya Hussain
- Pharmacy Department, Birmingham Women's and Children's NHS Trust, Birmingham, UK.
| | - Conor Jamieson
- Medical Directorate, NHS England (Midlands), Birmingham, UK.
| | - Shahzad Razaq
- Pharmacy Department, University Hospitals Birmingham NHS Trust, Birmingham, UK.
| | - Abi Jenkins
- Pharmacy Department, University Hospitals Birmingham NHS Trust, Birmingham, UK.
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Mthombeni TC, Burger JR, Lubbe MS, Julyan M. Public hospital pharmacists' knowledge, attitudes, and practices for antibiotic stewardship implementation in Limpopo Province, South Africa. J Pharm Health Care Sci 2024; 10:9. [PMID: 38303050 PMCID: PMC10832237 DOI: 10.1186/s40780-024-00331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/28/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Hospital pharmacists are important in antibiotic stewardship programs (ASP), a global strategy to combat antibiotic resistance (ABR). South African public hospitals have limited ASP implementation. This study describes Limpopo Provincial Hospital pharmacists' knowledge, attitudes, and practice toward ASP implementation. METHOD A questionnaire to explore pharmacists' knowledge, attitudes and practices regarding ASP implementation comprised 43 questions hosted online. A link was sent by invitation e-mail to eligible respondents in November 2021. Five questions on respondents' demographics, 15 questions on ASP knowledge, 10 Likert scale questions on attitude, and 13 on ASP practices were included. Mean (standard deviation (SD)) knowledge and attitude scores and a median (interquartile range (IQR)) practice score was calculated. Associations between categorical variables were assessed using chi-square/Fisher's exact analysis (p < 0.05), with Cramér's V as effect size. RESULTS The survey yielded 35 responses (13.1%). Twenty (57.1%) respondents were female. Seventeen (48.6%) respondents were between the ages of 31 and 40 years. The mean knowledge score of respondents was 9.8 (2.6) (N = 34), with knowledge gaps on One Health and socioeconomic determinates of ABR. Ten (29.6%) respondents thought One Health discouraged multi-sector collaboration, and nineteen (55.9%) respondents thought ASP was the only strategic response to ABR. Sixteen (47.1%) respondents did not know that poor access to clean water accelerates ABR and seventeen (50.0%) did not know that poverty could be a determinant for antibiotic use. The mean respondent attitude score was 8.0 (1.7) (N = 28). Twenty-seven (96.4%) respondents agreed that ASP was necessary and agreed to participate in ASP respectively. All 28 (100.0%) respondents agreed to lead an ASP. The median (IQR) respondents' practice score was - 2.0 (IQR: -6.0-5.8) (N = 16). Respondents were inconsistently (never, sometimes, every time) participating in multi-disciplinary forums (6/16, 37.5%) and expressed a desire for training (11/13, 84.6%) on ASP through in-service (7/27, 25.9%). Respondents thought ASP training should include medical officers (12/29, 41.4%) and nurses (9/29, 31.8%). Knowledge score was associated with gender (p = 0.048; V = 0.416) and attitude score (p = 0.013; V = 0.556). CONCLUSION Our study found pharmacists had good knowledge and a positive attitude toward ASP implementation but poor ASP practices. A multi-disciplinary in-service training could address identified knowledge and practice gaps.
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Affiliation(s)
- Tiyani Comfort Mthombeni
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Johanita Riétte Burger
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
| | - Martha Susanna Lubbe
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Marlene Julyan
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Lim J, Bang KS. Participation in and perceptions of antibiotic stewardship behaviors among nurses at a children's hospital in South Korea: a descriptive study. CHILD HEALTH NURSING RESEARCH 2024; 30:54-66. [PMID: 38302272 PMCID: PMC10834308 DOI: 10.4094/chnr.2023.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
PURPOSE This study investigated participation in and perceptions of antibiotic stewardship among nurses at a children's hospital. METHODS This descriptive study included 125 nurses working in the inpatient ward, intensive care unit and emergency room of a single tertiary children's hospital. The study measured 14 factors influencing antibiotic stewardship behaviors using the theoretical domains framework. Each factor was analyzed by categorizing it into components (capability, opportunity, and motivation) that have been proposed as influencing factors in the COM-B model of behavior. One-way analysis of variance and Pearson correlation coefficients were used to explore differences in antibiotic stewardship behaviors and influencing factors according to general characteristics and the correlation between antibiotic stewardship behaviors and COM-B components. RESULTS No statistically significant difference in antibiotic stewardship behaviors was found based on the experience of antibiotic stewardship education or the nursing department. However, significant differences were observed in the perception levels of factors related to antibiotic stewardship behaviors according to the experience of antibiotic stewardship education in skill (physical) (p=.042), knowledge (p=.027), intentions (p=.028), and social influences (p=.010). Additionally, significant differences were observed in perception levels according to the sub-components of the COM-B model, specifically physical capability (p=.042), psychological capability (p=.027), and social opportunity (p=.010). CONCLUSION To expand nurses' involvement and roles in antibiotic stewardship, nurses should acknowledge the significance of appropriate antibiotic use, aiming to enhance the quality of medical care and ensure patient safety. In pursuit of this objective, tailored education aligning with the specific needs and practices of nurses is essential.
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Affiliation(s)
- Jihee Lim
- Doctoral Candidate, College of Nursing, Seoul National University, Seoul, Korea
| | - Kyung-Sook Bang
- Professor, College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use. JAC Antimicrob Resist 2023; 5:dlad123. [PMID: 38021036 PMCID: PMC10667038 DOI: 10.1093/jacamr/dlad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities. Conclusions Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
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Affiliation(s)
- Maria Bos
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cindy De Bot
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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Albalawi L, Alhawiti AS, Alnasser D, Alhumaidi J, Alrashidi T, Alnawmasi AM, Ali MAS, Alqifari S, Alshareef H. Knowledge, Attitudes, and Practices among Pharmacy and Non-Pharmacy Interns in Saudi Arabia Regarding Antibiotic Use and Antibiotic Resistance: A Cross-Sectional Descriptive Study. Healthcare (Basel) 2023; 11:healthcare11091283. [PMID: 37174825 PMCID: PMC10178345 DOI: 10.3390/healthcare11091283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
This cross-sectional descriptive study aims to explore the knowledge, attitudes, and practices among pharmacy, dentistry, medicine, and nursing interns in Saudi Arabia regarding antibiotic use and antibiotic resistance. Interns received a soft copy of a structured and validated self-administered questionnaire using an online survey platform. A total of 266 interns responded to the questionnaire. On average, the participants achieved good scores in the knowledge and practice domains, followed by the attitude domain. The average knowledge percentage was 76.1% (SD 17.1) compared to 84.6% (SD 20.5) for practices and 61.5% (SD 23.2) for attitudes. The results suggest that pharmacy interns had insignificantly better overall scores compared to non-pharmacy interns for knowledge, attitudes, and practices. This study shows that the scores for knowledge, attitudes, and practices of pharmacy, dentistry, medicine, and nursing interns regarding antibiotic use and resistance were high overall. However, interns' belief in their responsibility in preventing antibiotic resistance is lacking.
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Affiliation(s)
- Laila Albalawi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Abeer S Alhawiti
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Dania Alnasser
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | | | - Tahani Alrashidi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | | | - Mostafa A S Ali
- Pharmacy Practice Department, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
- Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Saleh Alqifari
- Pharmacy Practice Department, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hanan Alshareef
- Pharmacy Practice Department, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
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Bobbitt LJ, Cimino C, Garvey KV, Craft LS, Eichenseer NA, Nelson GE. An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e41. [PMID: 36960083 PMCID: PMC10028939 DOI: 10.1017/ash.2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 03/06/2023]
Abstract
Background Nurses perform several functions that are integral for antimicrobial stewardship (AMS). However, nurses are underrepresented in research and underutilized in implementation of AMS interventions. The objective of this pilot study was to assess the effect of asynchronous microlearning on inpatient nursing staff knowledge, attitudes, and practices (KAP) regarding AMS principles. Methods A team of pharmacists, physicians, and nurses developed 9 case-based, multiple-choice questions with accompanying educational explanations on associated AMS principles. One case was delivered to participants daily via an institutional web-based application (QuizTime). A KAP survey with 20 questions on a 5-point Likert scale was administered before and after the intervention. Survey results were compared using a Wilcoxon signed-rank test. Results Participants' mean survey score after the intervention demonstrated statistically significant improvement for 18 (90%) of 20 items compared to before the intervention. Participants' confidence improved in key AMS activities: (1) differentiating between colonization and infection (mean difference, 0.63; P < .001), (2) identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (mean difference, 0.94; P < .001), (3) recognizing opportunities for intravenous to oral therapy conversion (mean difference, 1.07; P < .001), and (4) assessing for antibiotic-associated adverse effects (mean difference, 0.54; P < .001). Conclusions Nursing education provided through an asynchronous, microlearning format via a mobile platform resulted in statistically significant improvement in most KAP topics. Nurses are integral members of a multidisciplinary AMS team, and novel education methods can help equip them with the necessary AMS tools. This pilot study forms the basis for expanded AMS educational efforts in all healthcare professionals.
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Affiliation(s)
- Laura J. Bobbitt
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
- Author for correspondence: Laura J. Bobbitt, PharmD, Department of Pharmaceutical Services, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN37232. E-mail:
| | - Christo Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim V. Garvey
- Department of Anesthesiology; Center for Advanced Mobile Healthcare Learning, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leanna S. Craft
- Department of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole A. Eichenseer
- Department of Nursing, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George E. Nelson
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Wise S, Smith E, Carlos L, Coleshill M, Day RO, Melocco T, Carland JE. Who is asking? Requests for antimicrobial prescribing advice received by hospital pharmacists. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health UNSW Sydney Kensington Australia
| | - Eloise Smith
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Darlinghurst Australia
- School of Medical Sciences UNSW Sydney Kensington Australia
| | - Lilibeth Carlos
- Pharmacy Department St Vincent's Hospital Darlinghurst Australia
| | - Matthew Coleshill
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health UNSW Sydney Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Darlinghurst Australia
- Black Dog Institute Randwick Australia
| | - Richard Osborne Day
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health UNSW Sydney Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Darlinghurst Australia
| | - Terry Melocco
- Pharmacy Department St Vincent's Hospital Darlinghurst Australia
| | - Jane Ellen Carland
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health UNSW Sydney Kensington Australia
- Department of Clinical Pharmacology and Toxicology St Vincent's Hospital Darlinghurst Australia
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Polisetty RS, Borkowski J, Georges D, Mowers S, Bolch C, Quiñones-Boex A, Murray M. Antibiotic Stewardship Attitudes and Beliefs Among Frontline Staff Nurses: Impact of Virtual Education. EMJ MICROBIOLOGY & INFECTIOUS DISEASES 2022. [DOI: 10.33590/emjmicrobiolinfectdis/10151610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Nurses are vital healthcare team members and are often underutilised in antimicrobial stewardship (AS) activities. Several nursing responsibilities, such as taking allergy history and obtaining cultures, already overlap with AS activities. Nurses can play a crucial role in promoting AS in resource-limited settings. This study was conducted to assess frontline staff nurses’ baseline attitudes and beliefs towards AS, and see if a virtual education campaign consisting of newsletters and tip sheets would affect those attitudes and beliefs.
Methods: An online survey (pre-survey) was conducted of all in-patient nurses employed in the authors’ hospital on their attitudes and beliefs regarding AS. The survey consisted of 24 questions divided into three domains: demographic and practice information, nursing roles, and beliefs and attitudes towards AS programmes (ASP). After obtaining the results of the pre-survey, the authors started distributing monthly newsletters on various AS topics via email and posting them on a resource page. Topics included how to obtain an accurate allergy history, how to use microbiology results to help guide decisions, and stop therapy in cases of colonisation. The authors also distributed the same survey as a follow-up 6-month survey (post-survey) in March 2021 to gauge the impact of their virtual education efforts.
Results: In total, 109 nurses working in the adult in-patient setting of the authors’ institution completed the pre-survey in September 2020, and 64 nurses completed the post-survey in March 2021. Overall, most nurses had a positive attitude towards AS tasks, and over 90% of those who responded in the pre-survey and post-survey agreed with the statement that nurses are antibiotic stewards, thought it was important or very important to obtain appropriate cultures, and understood the relationship between Clostridioides difficile and antibiotics. Most pre-survey respondents listed knowledge gaps in microbiology (47 out of 64 [86%]) and antibiotics (53 out of 64 [84%]) as well as scope of practice concerns (48 out of 64 [75%]) as barriers to nurse participation. The virtual education helped raise the familiarity with the ASP and more nurses in the post-survey said they were familiar with the stewardship programme compared with the pre-survey (48.4% versus 23.2%; p=0.001).
Conclusions: This study showed that most nurses consider themselves antibiotic stewards and want to participate in AS activities; however, barriers to nursing involvement, such as lack of knowledge, scope of practice concerns, and time constraints, persist. Virtual education may be an option to increase nursing awareness and participation on ASPs in resource-limited settings.
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Affiliation(s)
- Radhika S. Polisetty
- Department of Pharmacy, Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA; Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove Campus, Illinois, USA
| | - Jaime Borkowski
- Department of Infectious Diseases, Northwestern Medicine Delnor Hospital, Geneva, Illinois, USA
| | - Dorothy Georges
- Medical Care Center, Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA; Department of Professional Practice, Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Stacy Mowers
- Department of Professional Practice, Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Charlotte Bolch
- Office of Research and Sponsored Programs, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Ana Quiñones-Boex
- Midwestern University College of Pharmacy, Downers Grove Campus, Illinois, USA
| | - Milena Murray
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove Campus, Illinois, USA; Northwestern Medicine, Chicago, Illinois, USA
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Zhou LL, Zhou Q. Critical roles of nurses in rational use of antimicrobial agents through multidisciplinary collaboration. J Clin Nurs 2022. [PMID: 35644037 DOI: 10.1111/jocn.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ling-Ling Zhou
- VIP Geriatric Ward, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Quan Zhou
- Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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