Abstract
Introduction
Antimicrobial resistance (AMR) is an urgent public health concern and threatens to reduce the effectiveness of antimicrobials. High consumption, increased frequency and imprudent use of antimicrobials are believed to accelerate resistance and research suggests that inappropriate prescribing is apparent in practice. With a growing number of nurses prescribing antimicrobials, generating an understanding of their practice is essential to inform future strategies designed to combat AMR. Therefore the objective of this review was to systematically identify, appraise and synthesise the evidence in relation to the influences on independent nurse prescribers’ (NPs) antimicrobial prescribing behaviour.
Methods
A comprehensive search strategy was undertaken; databases (AMED, CINAHL, MEDLINE, Health Source: Nursing/Academic Edition), conference proceedings and reference lists were searched for English language studies from January 1st 2002 to 31st December 2013. Records identified were screened for relevance. Two independent reviewers assessed the methodological quality of the papers using critical appraisal tools and data was extracted.
Results
Five studies were found which explored influences on NPs’ antimicrobial prescribing behaviour and two which explored both NPs and doctors/physician assistants. Methodologically, survey design was most common with only one study adopting a qualitative approach. Guidelines, safety, tolerability and efficacy of the antibiotic and diagnostic uncertainty were the most common influencing factors. Other factors such as the clinical condition of the patient and patient/parent pressure, training/experience, peer support, cost, race and payment factors were also mentioned within the studies.
Discussion
These studies were limited by relatively poor response rates, small sample sizes, designs with no agreed theory and often failed to explore the underlying reasons. A methodology which allows for a more thorough exploration of all influencing factors on prescribing behaviour may be more useful to inform future behavioural strategies designed to be inclusive and relevant to this ever increasing group of prescribers.
Antimicrobial resistance (AMR) is an urgent public health concern and threatens to reduce the effectiveness of antimicrobials. High consumption, increased frequency and imprudent use of antimicrobials are believed to accelerate resistance and research suggests that inappropriate prescribing is apparent in practice. With a growing number of nurses prescribing antimicrobials, generating an understanding of their practice is essential to inform future strategies designed to combat AMR. Therefore the objective of this review was to systematically identify, appraise and synthesise the evidence in relation to the influences on independent nurse prescribers’ (NPs) antimicrobial prescribing behaviour.
Methods
A comprehensive search strategy was undertaken; databases (AMED, CINAHL, MEDLINE, Health Source: Nursing/Academic Edition), conference proceedings and reference lists were searched for English language studies from January 1st 2002 to 31st December 2013. Records identified were screened for relevance. Two independent reviewers assessed the methodological quality of the papers using critical appraisal tools and data was extracted.
Results
Five studies were found which explored influences on NPs’ antimicrobial prescribing behaviour and two which explored both NPs and doctors/physician assistants. Methodologically, survey design was most common with only one study adopting a qualitative approach. Guidelines, safety, tolerability and efficacy of the antibiotic and diagnostic uncertainty were the most common influencing factors. Other factors such as the clinical condition of the patient and patient/parent pressure, training/experience, peer support, cost, race and payment factors were also mentioned within the studies.
Discussion
These studies were limited by relatively poor response rates, small sample sizes, designs with no agreed theory and often failed to explore the underlying reasons. A methodology which allows for a more thorough exploration of all influencing factors on prescribing behaviour may be more useful to inform future behavioural strategies designed to be inclusive and relevant to this ever increasing group of prescribers.
| Original language | English |
|---|---|
| Publication status | Published - Sep 2014 |
Keywords
- public health
- antimicrobial resistance
- nurse prescribing
- prescribing behaviour