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Nurses can influence antibiotic prescribing

Making antibiotic sensitivity – through the nursing management of respiratory tract infections – a global priority in primary care.

Making antibiotic sensitivity through the nursing management of respiratory tract infections a global priority in primary care

Antimicrobial resistance represents one of the greatest patient safety challenges of our time. Conserving antibiotic sensitivity through the management of self-limiting respiratory tract infections (RTIs), the most frequent acute problems where patients consult in primary care, without recourse to antibiotics is a global priority.

Most of these infections are viral and self-limiting. Over prescribing medicalises them, reducing the likelihood that patients will adopt self-management strategies and perpetuating the belief that antibiotics are effective for common infections.

The last two decades have seen significant advances in the role and function of nurses, with innovative, expanded and extended roles and the authority to prescribe. In the UK, the number of nurses qualified to prescribe has steadily increased over the past five years, and around

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Making antibiotic sensitivity – through the nursing management of respiratory tract infections – a global priority in primary care


Picture: iStock

Antimicrobial resistance represents one of the greatest patient safety challenges of our time. Conserving antibiotic sensitivity through the management of self-limiting respiratory tract infections (RTIs), the most frequent acute problems where patients consult in primary care, without recourse to antibiotics is a global priority.

Most of these infections are viral and self-limiting. Over prescribing medicalises them, reducing the likelihood that patients will adopt self-management strategies and perpetuating the belief that antibiotics are effective for common infections.

The last two decades have seen significant advances in the role and function of nurses, with innovative, expanded and extended roles and the authority to prescribe. In the UK, the number of nurses qualified to prescribe has steadily increased over the past five years, and around 31,000 nurses have the same prescribing capability as doctors.

Little research

Nurse prescribers predominantly work in primary care and frequently prescribe for respiratory conditions and infections (Latter et al 2010, Courtenay et al 2012). However, there is little evidence available on the prescription of antibiotics by nurse prescribers and existing research has focused on GP prescribing decisions for patients with acute RTIs.

A mixed method study by researchers at Cardiff University explored patient experiences of non-medical prescriber (NMP) management of RTIs and how this impacts patient satisfaction (Courtenay et al 2017). It identified that 43% of patients with a RTI expect an antibiotic when consulting a nurse prescriber, but that those expectations were not associated with receipt of medications.

GPs, in contrast, have been found to be more likely to prescribe antibiotics if they perceive that the patient expects one. Cardiff University researchers found that over 80% of patients received patient-centred management strategies (such as taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions), and this encouraged patients to share personal information, raise their concerns and seek clarification about their condition. High levels of satisfaction were reported by patients for all aspects of the consultation.

Developing understanding

Educational interventions designed to reduce inappropriate antibiotic prescribing are based on research with GPs and few have been translated into routine healthcare practice. Nurses have good communication skills, and a strength of nurse consultations is their ability to elicit the patient agenda.

Given that the way this agenda is explored in consultations can influence patient outcomes (Barry et al 2000), it is important to develop our understanding of how this relatively new group of prescribers deliver this task in RTI consultations and contribute to patient care.

Patient satisfaction study

A mixed methods study explored patient experiences of non-medical prescriber (NMP) management of RTIs and how this impacts patient satisfaction. Qualitative data (semi-structured interviews with patients and NMPs) and quantitative data (patient questionnaires) were collected from 120 patients and NMPs (16 nurses and 1 pharmacist), working in primary care across England, Scotland, and Wales, following consultations for RTIs.

 

References

  • Barry CA, Bradley CP, Britten N et al (2000) Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ. 320, 7244, 1246-5.
  • Courtenay M, Carey N, Stenner K (2012) An overview of non medical prescribing across one strategic health authority: a questionnaire survey. BMC Health Services Research. 12, 138 doi:10.1186/1472-6963-12-138.
  • Courtenay M, Rowbotham S, Lim R, et al (2017) Antibiotics for acute respiratory tract infections; A mixed methods study of patient experiences of non-medical prescriber management. BMJ Open. 7, 3, e013515.
  • Latter S, Maben J, Myall M et al (2005) An evaluation of extended formulary independent nurse prescribing: executive summary. Southampton, UK, University of Southampton School of Nursing and Midwifery on behalf of Department of Health.
  • Latter S, Blenkinsopp A, Smith A et al (2010) Evaluation of nurse and pharmacist independent prescribing. University of Southampton and University of Keele on behalf of Department of Health.
  • Stenner K, Courtenay M, Carey N (2011)  Consultations between nurse prescribers and patients with diabetes in primary care: a qualitative study of patients views.  International Journal of Nurse Studies. 48, 37-46.

About the author

Molly Courtenay is professor at school of healthcare Sciences, Cardiff University

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