Antimicrobial prescribing and stewardship

The last research roundup provided you with an overview of some papers relating to prescribing of statins and lipid modification goals in the management of hyperlipidaemia and prevention of cardiovascular disease (Robertson, 2021). This month we will review papers published looking at antimicrobial prescribing all with a connection to and discussion around the role of antimicrobial stewardship and the prescriber.

This mixed methods study using a reasoned action approach in the Journal of Hospital Infection aimed to measure nurse independent prescribers' (NIPs) intention to manage patients, presenting with an upper respiratory tract infection (URTI) for the first time, without prescribing an antibiotic and to examine the determinants of this behaviour in order to provide evidence in this under researched area (Ness et al, 2021). The authors conducted telephone interviews with 27 NIPs and used the content of these interviews to inform the development of a questionnaire around intention to manage in this presentation. The questionnaire was used in a national survey of NIPs (after testing for validity and reliability) across Scotland. The survey included 184 participants from a mixed urban and rural setting and across primary and secondary care. Information was also gathered about years qualified as a NIP. The authors found that from the information collected it was found that NIPs intended to manage patients, presenting with a URTI for the first time, without prescribing an antibiotic. Key determinants were perceived norm, perceived behavioural control, and moral norm. Significant beliefs were positive social influence from other non-medical prescribers and nurse prescribers the enablers of prescriber experience and confidence. They state the pressure from patients/carers for them to prescribe as a barrier. This pressure finding supports evidence in the medical prescribing literature and suggests NIPs face similar pressures to their medical colleagues.