Medicines management

I am a nurse prescriber and my patient is insisting I give him antibiotics even though he doesn’t need them. I have tried explaining this, but he will not listen. Do you have any advice?

This is an increasingly common problem which is becoming a real concern for practitioners. Surveys have shown that nine out of ten doctors have felt under pressure to prescribe antibiotics where patients have requested them, while other figures suggest that nearly all patients who ask for antibiotics get them.

According to recent guidance from the National Institute for Health and Care Excellence, around 10 million of the 40 million prescriptions for antibiotics issued in the UK last year were unnecessary, contributing to increased antibiotic resistance. The guidance, issued last month, is aimed at driving down the amount of prescriptions for antibiotics issued by health professionals.

There will always be patients who feel they need antibiotics for every event, but the decision whether to prescribe them or not has to be taken on a case-by-case basis. Explaining the reasons why antibiotics are not required can take time, but nurses must act as responsible antibiotic stewards and not simply print offa prescription to meet a patient’s expectations.

If patients do not receive the treatment they want, they will often go elsewhere for an opinion. If you are the second or third opinion practitioner, it is essential that the consultation is comprehensive to ensure the need for antibiotics has not changed. But if the patient still does not need antibiotics, this must be reiterated, backing the original practitioner’s refusal.

Antibiotic resistance is a worldwide problem. With increased resistance, there is a likelihood that thousands of people could die as a result of simple infections over the next ten to 20 years.

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