Stocktake Sale on now: wide range of books at up to 70% off!
Register      Login
Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Nurse prescriber’s understanding of their antimicrobial stewardship role: a qualitative study

Anecita Gigi Lim 1 , Dianne C. Marshall https://orcid.org/0000-0001-8050-9664 1 * , Kenzie Roberts 1 , Michelle L. L. Honey 1
+ Author Affiliations
- Author Affiliations

1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand.

* Correspondence to: di.marshall@auckland.ac.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 15(3) 274-280 https://doi.org/10.1071/HC23006
Published: 20 July 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Antimicrobial resistance is an infectious disease threat to public health globally, and antimicrobial stewardship among healthcare professionals is one key way to address this potential problem. Registered nurse designated prescribers are the newest group of health professionals to gain prescribing authority in Aotearoa New Zealand, yet little is known about their understanding of their antimicrobial stewardship role.

Aim

The aim of this study was to explore registered nurse designated prescribers’ understanding of their antimicrobial stewardship role through their prescribing practices and approaches to clinical reasoning.

Methods

This exploratory descriptive qualitative study used individual semi-structured interviews with six registered nurse designated prescribers. Thematic analysis was used to analyse the interviews.

Results

Four themes were identified: antibiotic prescribing practices and antimicrobial resistance; clinical indicators for prescribing antibiotics, with the sub-themes of history taking, presence of infection and bacterial versus viral infection; patient education; and safety and monitoring. These themes provide insight into registered nurse designated prescribers’ understanding of their antimicrobial stewardship role and prescribing of antibiotics.

Discussion

This research found that the registered nurse designated prescribers had an awareness of the importance of their antimicrobial stewardship role in relation to antibiotic prescribing and reducing antimicrobial resistance. Education about antimicrobial resistance and antimicrobial stewardship for this professional group can be effective, but further research is needed to understand their ongoing educational needs.

Keywords: antibiotics, antibiotic efficacy, antibiotic resistance, antimicrobial agents, antimicrobial resistance, antimicrobial stewardship, nursing, nurse prescribers.

References

Khan F, Arthur J, Maidment L, et al. Advancing antimicrobial stewardship: summary of the 2015 CIDSC Report. Can Commun Dis Rep 2016; 42(11): 238-41.
| Crossref | Google Scholar |

de Kraker MEA, Stewardson AJ, Harbarth S. Will 10 million people die a year due to antimicrobial resistance by 2050? PLoS Med 2016; 13(11): e1002184.
| Crossref | Google Scholar |

Ahmad M, Khan AU. Global economic impact of antibiotic resistance: a review. J Glob Antimicrob Resist 2019; 19: 313-6.
| Crossref | Google Scholar |

World Health Organization. Global antimicrobial resistance surveillance system (GLASS) report: early implementation 2017-2018, World Health Organization. 2018.

World Health Organization. Global action plan on antimicrobial resistance. 2015.

Peterson E, Kaur P. Antibiotic resistance mechanisms in bacteria: relationships between resistance determinants of antibiotic producers, environmental bacteria, and clinical pathogens. Front Microbiol 2018; 9: 2928.
| Crossref | Google Scholar |

Richardson LA. Understanding and overcoming antibiotic resistance. PLoS Biol 2017; 15(8): e2003775.
| Crossref | Google Scholar |

Thomas MG, Smith AJ, Tilyard M. Rising antimicrobial resistance: a strong reason to reduce excessive antimicrobial consumption in New Zealand. N Z Med J 2014; 127(1394): 72-84.
| Google Scholar |

Cars O, Nordberg P. Antibiotic resistance – the faceless threat. Int J Risk Saf Med 2005; 17: 103-10.
| Google Scholar |

10  Kollipara R, Downing C, Lee M, et al. Current and emerging drugs for acute bacterial skin and skin structure infections: an update. Expert Opin Emerg Drugs 2014; 19(3): 431-40.
| Crossref | Google Scholar |

11  Nuermberger EL, Bishai WR. Antibiotic resistance in Streptococcus pneumoniae: what does the future hold? Clin Infect Dis 2004; 38: S363-71.
| Crossref | Google Scholar |

12  Abera B, Kibret M, Mulu W. Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia. BMC Pharmacol Toxicol 2014; 15(1): 26.
| Crossref | Google Scholar |

13  Bartlett JG, Gilbert DN, Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis 2013; 56(10): 1445-50.
| Crossref | Google Scholar |

14  Manning ML, Pfeiffer J, Larson EL. Combating antibiotic resistance: the role of nursing in antibiotic stewardship. Am J Infect Control 2016; 44(12): 1454-7.
| Crossref | Google Scholar |

15  Moody J, Cosgrove SE, Olmsted R, et al. Antimicrobial stewardship: a collaborative partnership between infection preventionists and healthcare epidemiologists. Infect Control Hosp Epidemiol 2012; 33(4): 328-30.
| Crossref | Google Scholar |

16  American Nurses Association. Redefining the antimicrobial stewardship team: recommendation from the American Nurses Association/Centre for Disease Control and Prevention Workgroup on the role of registered nurses in hospital antimicrobial stewardship practices. 2017. Available at https://www.cdc.gov/antibiotic‐use/healthcare/pdfs/ana‐cdc‐whitepaper.pdf

17  Abbo L, Smith L, Pereyra M, et al. Nurse practitioners’ attitudes, perceptions, and knowledge about antimicrobial stewardship. J Nurse Pract 2012; 8(5): 370-6.
| Crossref | Google Scholar |

18  Castro-Sánchez E, Drumright LN, Gharbi M, et al. Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom. PLoS One 2016; 11(2): e0150056.
| Crossref | Google Scholar |

19  Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence 2013; 4(2): 192-202.
| Crossref | Google Scholar |

20  Raghunandan R, Tordoff J, Smith A. Non-medical prescribing in New Zealand: an overview of prescribing rights, service delivery models and training. Ther Adv Drug Saf 2017; 8(11): 349-60.
| Crossref | Google Scholar |

21  Nursing Council of New Zealand. Tapuhi tūtohu kua rēhitatia ‐ Registered Nurse Prescribing. 2018. Available at https://www.nursingcouncil.org.nz/Public/Nursing/Nurse_prescribing/NCNZ/nursing‐section/Nurse_Prescribing.aspx

22  Key J, Hoare K. Nurse prescribing in New Zealand—the difference in levels of prescribing explained. N Z Med J 2020; 133(1524): 111.
| Google Scholar |

23  Olans RN, Olans RD, DeMaria Jr A. The critical role of the staff nurse in antimicrobial stewardship—unrecognized, but already there. Clin Infect Dis 2015; 62(1): 84-9.
| Crossref | Google Scholar |

24  Padigos J, Ritchie S, Lim AG. Enhancing nurses’ future role in antimicrobial stewardship. Collegian 2020; 27(5): 487-98.
| Crossref | Google Scholar |

25  Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice, 9th edn. Philadelphia, PA: Wolters Kluwer; 2018.

26  Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6): 349-57.
| Crossref | Google Scholar |

27  Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |

28  Marston HD, Dixon DM, Knisely JM, et al. Antimicrobial resistance. JAMA 2016; 316(11): 1193-204.
| Crossref | Google Scholar |

29  Kronman MP, Zhou C, Mangione-Smith R. Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections. Pediatrics 2014; 134(4): e956-65.
| Crossref | Google Scholar |

30  Mangione-Smith R, Zhou C, Robinson JD, et al. Communication practices and antibiotic use for acute respiratory tract infections in children. Ann Fam Med 2015; 13(3): 221-7.
| Crossref | Google Scholar |

31  Weddle G, Goldman J, Myers A, et al. Impact of an educational intervention to improve antibiotic prescribing for nurse practitioners in a pediatric urgent care center. J Pediatr Health Care 2017; 31(2): 184-8.
| Crossref | Google Scholar |

32  Williamson JML, Martin AG. Analysis of patient information leaflets provided by a district general hospital by the Flesch and Flesch–Kincaid method. Int J Clin Pract 2010; 64(13): 1824-31.
| Crossref | Google Scholar |

33  Drennan VM, Grant RL, Harris R. Trends over time in prescribing by English primary care nurses: a secondary analysis of a national prescription database. BMC Health Serv Res 2014; 14: 54-62.
| Crossref | Google Scholar |

34  Rocha-Pereira N, Lafferty N, Nathwani D. Educating healthcare professionals in antimicrobial stewardship: can online-learning solutions help? J Antimicrob Chemother 2015; 70(12): 3175-7.
| Crossref | Google Scholar |

35  Ohl CA, Luther VP. Health care provider education as a tool to enhance antibiotic stewardship practices. Infect Dis Clin North Am 2014; 28(2): 177-93.
| Crossref | Google Scholar |

36  Martin CM. Antibiotic stewardship: new frontier, familiar journey. Consult Pharm 2017; 32: 27-32.
| Crossref | Google Scholar |