In this article the concept of using hard enamel lanyard pins as a simple antimicrobial stewardship nudging tool is discussed.
Authored by: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
🤓 You can find the pins discussed in this article here or click on any pin image below 🤓
Last updated: 28 November 2021
In 2014 Dr. Daniella Meeker and colleagues published an article in JAMA about nudging guideline-concordant antibiotic prescribing. Designed as a behavioral nudge to influence decision making through a subtle cognitive mechanism, in their study they posted commitment letters about appropriate antibiotic use within outpatient primary care settings. Ultimately they found a positive impact of this practice and in recent years the role of different types of nudges has been a topic of interest. For example, here is an article about nudging in the microbiology laboratory.
Using posters as a nudge tool for antimicrobial stewardship was so well received by the infectious diseases community that now the CDC provides sample commitment posters (available here) that institutions can adopt for local use.
With all of this talk about nudging and visual messages to encourage good clinical practices, it got me thinking about other potential nudge mechanisms. This in part led to developing a partnership with @VinPin (a critical care physician and pin-enthusiast on Instagram) to produce the pins discussed in this post.
Can hard enamel pins be used as a simple antimicrobial stewardship nudging tool? I think so. Here is how some of these pins can be used to spur conversation and remind people about using antibiotics wisely…
ANTIBIOTIC DEFENDER PIN
This is the most self-explanatory of the pins discussed here. This pin can help let other people know that you care about antibiotics and encourage discussions about what an “antibiotic defender” is plus why we all need to take steps to preserve antibiotics. Having key individuals in leadership positions don this type of pin may help encourage an organizational culture of good stewardship.
FIGHT ANTIBIOTIC RESISTANCE PIN
Boxing gloves are a readily identifiable symbol for engaging in combat. We may not physically engage with bad bugs in this fashion, but it gets the message across about being in a battle to save antibiotics from drug resistance.
TALK PILLS TO ME PIN
This second pin can serve as a reminder to discuss the patients current medication plan or it can serve to identify you are someone who can have a conversation with patients about their medicines. A visual representation of a discussion and a pill uses symbolism to communicate, thus simplifying the message and role of the individual wearing it.
STAPH WARS PIN
Methicillin Resistant Staphylococcus aureus (MRSA) aka “staph” infections are a big deal and can contribute to considerable morbidity and mortality. Many healthcare institutions place significant efforts towards reducing the amount of MRSA infections that may be avoidable. If a program is looking to wage war on this tiny yet mighty foe, a pin like this may help to remind people that tasks like chlorhexidine bathing, good hand hygiene, and nasal decolonization are important towards preventing MRSA central line associated bloodstream infections (CLABSIs). Would a shiny golden pin help to advance a MRSA CLABSI initiative? I think maybe.
WASH YOUR HANDS – BACTERIA GROWING ON AGAR
Hand hygiene is a cornerstone for infection prevention and control programs. This pin displays the words “wash your hands” as bacterial colonies growing on an agar plate. Seeing this pin shine golden (particularly when worn by a person of influence) can be a great way to remind people to keep including good hand hygiene in their workflow.
PLACEBO PIN
The first question to ask when it comes to antibiotics is: do we even need antibiotics? This colorful retro pin may serve as a reminder to consider what benefit a drug is having for the patient. Is that vancomycin and piperacillin-tazobactam no better than placebo at treating this patients active infection? In the hospital this is something that should be considered every day, often multiple times per day.
Closing comments
I hope you found this article interesting and that it inspires you to use innovative strategies to engage in antimicrobial stewardship. If you are interested in purchasing the pins shown on this blog post, you can find them in the VinPin store here while supplies last.
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