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Evaluation of factors influencing antibiotic prescribing behaviour by independent nurse prescribers

02 March 2024
Volume 6 · Issue 3


Antibiotic resistance is an urgent, accelerating global health threat due to inadequate infection prevention and control practices, and sub-optimal prescribing of antibiotics. Health professionals are required to practise antimicrobial stewardship to reduce incidence of antibiotic resistance, and this includes optimal prescribing behaviours. This study aimed to establish factors influencing medical prescribers' and independent nurse prescribers' antibiotic prescribing decisions, and compare the responses between practice settings. Independent nurse prescribers were invited to complete an online questionnaire with 17 antibiotic prescribing statements. Respondents rated their responses on a five-point Likert-type scale ranging from totally disagree to totally agree. A total of 115 questionnaires were completed and analysed. The results showed independent nurse prescribers' antibiotic prescribing decisions may be influenced by patient expectations, diagnostic uncertainty, challenges related to patient follow-up, time pressures and remote consultations. Unlike medical prescribers, they do not report pressure to prescribe antibiotics to maintain a good relationship with the patient. Antibiotic prescribing decisions are influenced by a wide range of factors outside of clinical indication and further research is required to explore these in detail. Independent nurse prescribers require education and training tailored to their specific needs and practice settings.

Antibiotic resistance is an urgent global health threat that is accelerating due to inadequate infection prevention and control practices, and sub-optimal prescribing of antibiotics (National Institute for Health and Care Excellence (NICE), 2015; World Health Organization (WHO), 2020). The effectiveness of antibiotics to treat bacterial infections is diminishing and, currently, there is little evidence to suggest new antibiotics will be effective or available (WHO, 2020). Infections are becoming harder to treat, with a consequent increase in medical costs, length of hospital stays and mortality rates (WHO, 2020).

Reducing the incidence of antibiotic resistance requires ‘antimicrobial stewardship’, defined as ‘an organisational or healthcare system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future’ (NICE, 2015). This requires prescribers to be aware of the public health implications of antibiotic use and follow appropriate prescribing behaviours (Ness et al, 2016).

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