Advance Practice Registered Nurses’ (APRNs') Clinical Practice Strategies to Deter Antibiotic Overuse

2.50
Hdl Handle:
http://hdl.handle.net/10755/621862
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Advance Practice Registered Nurses’ (APRNs') Clinical Practice Strategies to Deter Antibiotic Overuse
Other Titles:
Use of Antibiotics
Author(s):
Willson, Pamela; Lee, Susan K.; Poole, Marcia
Lead Author STTI Affiliation:
Beta Beta (Houston)
Author Details:
Pamela Willson, PhD, APRN, FNP-BC, CNE, FAANP, Professional Experience: Dr. Willson is a Sigma Theta Tau, International Henderson Fellow and past-president of the Beta Beta Chapter, Houston, Texas. Her research interests include chronic disease self-management, interdisciplinary team geriatric education. She has authored 65 plus articles and book chapters and is an experienced international/national presenter. Dr. Willson is Clinical Professor at the Texas State University, Round rock, TX. Since 1985 she has taught APRNs, nurse educators, and nurse administrators in graduate and doctoral programs. Author Summary: Dr. Willson is a Sigma Theta Tau, International Virginia Henderson Fellow. She has taught graduate level nursing for 31 years. A focus of her research agenda has been standardize testing, self-management, and access to care for multicultural populations.
Abstract:

Purpose: Despite evidence that unnecessary antibiotic therapy for acute respiratory tract infections (ARTIs) increases risk of adverse drug events, increases antibiotic-resistant bacteria and healthcare costs, while not providing clinical improvement, prescription use is common. While there are reports of physician clinical practice strategies to deter antibiotic overuse, no studies specific to Advanced Practice Nurses’ (APNs) practice behaviors were found. The provider’s communication of positive and negative treatment recommendations leans to support for deterring antibiotic misuse. The primary aim of this study was to describe APNs clinical strategies to reduce antibiotic overuse for ARTIs in pediatric patients.

Methods: The conceptual model of evidence-based guideline adherence framed the Case Scenario Questionnaire. A random sample (N=3,000) of Family and Pediatric APN members of the Texas Nurse Practitioner professional organization were invited to participate. Two hundred and sixty-eight (N=268) APNs responded to the electronic 35-item survey and free-text Case Scenario Questionnaire. The Case Scenario Questionnaire was developed and field-tested prior to the project and contained a color image of the case study patient’s oropharynx. The questionnaire content addressed: 1) recognition of ARTI guidelines, 2) use of point-of-care testing, 3) identification of communication strategies, and 4) determination of clinical practice comfort care alternative and complementary management recommendations.

Thirteen participants were not currently practicing and, therefore, did not meet inclusion criteria. Most respondents’ specialty practice was primary care [i.e., family (n=155, 62%), adult/gerontology (n= 26, 10%), pediatrics (n=19, 8%)], followed by 16 (6%) in acute care. Neonatal, woman’s health, psych/mental health, and emergency room APNs comprised the remaining 34 (14%) respondents. Most APNs practiced in urban areas (n=189, 75%) for 1 to 37 years.

Results:  Point of care rapid strep testing was performed by 60% (n=135) of the APNs, 35% (n=78) of clinics did not have testing, and 6% reported the test unnecessary to diagnose ARTI. Of those who use rapid tests, a negative result lead to 43% (n=56) proceeding to throat culture prior to prescribing antibiotic. Fifteen percent (n=19) did not prescribe an antibiotic, but educated the patient and family on home remedies for symptom management. Antibiotic contingency plans were utilized by 71% (n=151) APNs and primarily consisted of calling the patient in 48-72 hours to verify the patient’s condition. I If no improvement was reported, antibiotics were prescribed. Fifty-nine percent (n=112) of patients’/parents’ expectations to receive antibiotics affected the decision to prescribe antibiotics. The most common reason for not prescribing antibiotics was that the illness was viral. Recommended symptomatic care strategies included: fluids and rest (n=147, 82%) and over-the-counter acetaminophen, decongestants, or cough medicine (n=113, 63%). Alternative therapies recommended were: saline nasal irrigation twice a day (n=72, 40%), Vitamin C 500 to 1000 mg three times a day for first 3-4 days (n=38, 21%)and zinc gluconate or acetate every 2 hours while awake (n=33,19%). Comparison rates for guideline adherence, as well as types and rates of comfort care strategies used, were reported.

 Conclusion: Patient/parents expect antibiotics for symptoms that are of viral etiology. Texas APNs must stay abreast of national guidelines of care for ATRIs and are implementing patient/parent education and clinical strategies to decrease the overuse of antibiotics for patients. Since contingency plans and patient-centered education are methods to avoid antibiotic overuse, challenges exist to address system approaches for APNs’ unique practice settings.

Keywords:
Advance Practice Nurses; Alternative Strategies; Antibiotic Overuse
Repository Posting Date:
17-Jul-2017
Date of Publication:
17-Jul-2017
Other Identifiers:
INRC17E17
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleAdvance Practice Registered Nurses’ (APRNs') Clinical Practice Strategies to Deter Antibiotic Overuseen_US
dc.title.alternativeUse of Antibioticsen
dc.contributor.authorWillson, Pamelaen
dc.contributor.authorLee, Susan K.en
dc.contributor.authorPoole, Marciaen
dc.contributor.departmentBeta Beta (Houston)en
dc.author.detailsPamela Willson, PhD, APRN, FNP-BC, CNE, FAANP, Professional Experience: Dr. Willson is a Sigma Theta Tau, International Henderson Fellow and past-president of the Beta Beta Chapter, Houston, Texas. Her research interests include chronic disease self-management, interdisciplinary team geriatric education. She has authored 65 plus articles and book chapters and is an experienced international/national presenter. Dr. Willson is Clinical Professor at the Texas State University, Round rock, TX. Since 1985 she has taught APRNs, nurse educators, and nurse administrators in graduate and doctoral programs. Author Summary: Dr. Willson is a Sigma Theta Tau, International Virginia Henderson Fellow. She has taught graduate level nursing for 31 years. A focus of her research agenda has been standardize testing, self-management, and access to care for multicultural populations.en
dc.identifier.urihttp://hdl.handle.net/10755/621862-
dc.description.abstract<p><strong>Purpose: </strong><span>Despite evidence that unnecessary antibiotic therapy for acute respiratory tract infections (ARTIs) increases risk of adverse drug events, increases antibiotic-resistant bacteria and healthcare costs, while not providing clinical improvement, prescription use is common. While there are reports of physician clinical practice strategies to deter antibiotic overuse, no studies specific to Advanced Practice Nurses’ (APNs) practice behaviors were found. The provider’s communication of positive and negative treatment recommendations leans to support for deterring antibiotic misuse. The primary aim of this study was to describe APNs clinical strategies to reduce antibiotic overuse for ARTIs in pediatric patients.</span></p> <p><strong>Methods: </strong>The conceptual model of evidence-based guideline adherence framed the Case Scenario Questionnaire. A random sample (N=3,000) of Family and Pediatric APN members of the Texas Nurse Practitioner professional organization were invited to participate. Two hundred and sixty-eight (N=268) APNs responded to the electronic 35-item survey and free-text Case Scenario Questionnaire. The Case Scenario Questionnaire was developed and field-tested prior to the project and contained a color image of the case study patient’s oropharynx. The questionnaire content addressed: 1) recognition of ARTI guidelines, 2) use of point-of-care testing, 3) identification of communication strategies, and 4) determination of clinical practice comfort care alternative and complementary management recommendations.</p> <p>Thirteen participants were not currently practicing and, therefore, did not meet inclusion criteria. Most respondents’ specialty practice was primary care [i.e., family (n=155, 62%), adult/gerontology (n= 26, 10%), pediatrics (n=19, 8%)], followed by 16 (6%) in acute care. Neonatal, woman’s health, psych/mental health, and emergency room APNs comprised the remaining 34 (14%) respondents. Most APNs practiced in urban areas (n=189, 75%) for 1 to 37 years.</p> <p><strong>Results: </strong> Point of care rapid strep testing was performed by 60% (n=135) of the APNs, 35% (n=78) of clinics did not have testing, and 6% reported the test unnecessary to diagnose ARTI. Of those who use rapid tests, a negative result lead to 43% (n=56) proceeding to throat culture prior to prescribing antibiotic. Fifteen percent (n=19) did not prescribe an antibiotic, but educated the patient and family on home remedies for symptom management. Antibiotic contingency plans were utilized by 71% (n=151) APNs and primarily consisted of calling the patient in 48-72 hours to verify the patient’s condition. I If no improvement was reported, antibiotics were prescribed. Fifty-nine percent (n=112) of patients’/parents’ expectations to receive antibiotics affected the decision to prescribe antibiotics. The most common reason for not prescribing antibiotics was that the illness was viral. Recommended symptomatic care strategies included: fluids and rest (n=147, 82%) and over-the-counter acetaminophen, decongestants, or cough medicine (n=113, 63%). Alternative therapies recommended were: saline nasal irrigation twice a day (n=72, 40%), Vitamin C 500 to 1000 mg three times a day for first 3-4 days (n=38, 21%)and zinc gluconate or acetate every 2 hours while awake (n=33,19%). Comparison rates for guideline adherence, as well as types and rates of comfort care strategies used, were reported.</p> <p> <strong>Conclusion: </strong>Patient/parents expect antibiotics for symptoms that are of viral etiology. Texas APNs must stay abreast of national guidelines of care for ATRIs and are implementing patient/parent education and clinical strategies to decrease the overuse of antibiotics for patients. Since contingency plans and patient-centered education are methods to avoid antibiotic overuse, challenges exist to address system approaches for APNs’ unique practice settings.</p>en
dc.subjectAdvance Practice Nursesen
dc.subjectAlternative Strategiesen
dc.subjectAntibiotic Overuseen
dc.date.available2017-07-17T14:44:25Z-
dc.date.issued2017-07-17-
dc.date.accessioned2017-07-17T14:44:25Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.