Abstract / Summary
Background: Antimicrobial resistance poses a growing threat to patient safety worldwide. Nurses are central to antimicrobial management; however, their contribution to formal antimicrobial stewardship (AMS) programs remains poorly characterized. To our knowledge, no previous review has combined evidence on the effectiveness and implementation of nurse-led and nurse-involved AMS interventions, including Gulf Cooperation Council and Middle East and North Africa (GCC/MENA) subgroup analysis.
Objective: This protocol describes a mixed methods systematic review that aims to determine (1) the effectiveness of nurse-led or nurse-involved AMS interventions on patient and antimicrobial outcomes in hospital and primary care settings and (2) the barriers and facilitators influencing this implementation using the Consolidated Framework for Implementation Research (CFIR 2.0).
Methods: This review follows the Joanna Briggs Institute convergent, parallel-streams mixed methods methodology. Eligible studies report a nurse-led or nurse-involved AMS intervention among adults receiving antimicrobial therapy in hospital or primary care settings; pediatric-only and long-term care settings are excluded. Eleven databases will be searched from January 2000 to the calendar month of searching. Two reviewers will independently screen records in 2 rounds, with agreement quantified by Cohen κ (target ≥0.70). The quantitative stream will include randomized, quasi-experimental, interrupted time series, and controlled before-and-after studies, with effect measures matched to outcome type. Risk of bias will be independently assessed using design-matched tools. Random-effects meta-analysis will be the primary approach, with prediction intervals supplementing I² to quantify heterogeneity. The qualitative stream will synthesize implementation data through hybrid deductive-inductive CFIR 2.0 thematic synthesis. Both streams will be integrated through a convergent joint display classifying findings as convergent, complementary, expansive, or discordant. Three primary subgroup analyses will compare GCC/MENA vs the rest of the world, hospital vs primary care, and levels of nursing involvement. GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be applied to all primary quantitative outcomes.
Results: Database searches, Covidence import, and deduplication were completed in March 2026. Title and abstract screening, including pilot calibration, was completed by June 2026. Full-text screening was planned for completion by August 2026, followed by parallel quantitative and qualitative data extraction from August to September 2026. Meta-analysis, CFIR thematic synthesis, and GRADE assessment are expected by November 2026, with mixed methods integration planned for November to December 2026. Manuscript writing is planned for January to February 2027, with submission targeted for March 2027. No amendments to the registered protocol have occurred.