A patient suffering from an unspecified upper respiratory tract infection checked into the hospital. In the previous hospital visit, the patient had received an antibiotic prescription for a similar condition, which resulted in marginal therapeutic benefits. Therefore, the patients request for another antibiotics prescription for the condition. However, as a primary caregiver, I had the responsibility to prevent the over-prescription or unnecessary prescription of antibiotics. The increasing levels of bacterial resistance necessitate the need for the adoption of antibiotic-justified diagnoses (Pollack & Srinivasan, 2014). Therefore, I declined to hand the prescription, and instead, advised the patient to wait for a diagnosis.
Despite the multiple publications by the Alliance Working for Antibiotic Resistance Education (AWARE), over-prescription of antibiotics continues to be a common practice by physicians (Thomas et al., 2013). The persistent antibiotic prescribing culture is a result of multiple factors. First, in other countries, antibiotics are easily accessible through over the counter purchases. The easy access, coupled with the public naivety about the seriousness of the resistance issue, contribute to the widespread usage of antibiotics. Therefore, patients who might have experienced relief by using these antibiotics will readily accept new prescriptions from a physician. In addition, the broad-spectrum effect of antibiotics allows physicians to offer empiric treatment for illnesses without any form of diagnosis or microbiological discovery (Thomas et al., 2013; Castro-Sánchez et al., 2019 ). The diagnostic uncertainty as to whether a patient is suffering from a viral or bacterial infection promotes presumptive antibiotic use.
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Instead of prescribing antibiotics to the patient upon request, I requested him to wait for the outcome of diagnostics to ascertain whether he was suffering from a bacterial infection. Although it was difficult to educate a sick person, I opted to share the knowledge about the consequences of unnecessary prescription of antibiotics with the patient. Furthermore, although I should be considerate towards the patient, I maintained a firm stand against the undiagnosed prescription of antibiotics. I assured the patient that I was trying to help him by delivering better healthcare services and used the opportunity to address the myth of antibiotic being a “miracle drug”.
The diagnosis was completed within a short period. The patient did not have any bacterial infection. Therefore, the prescription of antibiotics would have been unnecessary. The experience with the patient made me understand my role as a primary caregiver. I had the responsibility of ensuring that patients receive the best medical advice possible to avoid putting themselves in a dangerous situation (Castro-Sanchez et al., 2019). Besides, I also understood my role as a nurse practitioner in the antimicrobial stewardship program.
Patients have high expectations for antibiotics. The culture of undiagnosed prescription of antibiotics and over-the-counter purchases has led to the development of a notion that antibiotics are effective prescriptions (Pollack et al., 2014). Therefore, information that contradicts the patient’s belief is very hard to believe. Besides, patients have successfully cured various illnesses using these antibiotics in the past. Thus, patients may go through a period of denial.
By writing this paper, I have learned about bacterial resistance and the role I play, as a nurse practitioner, in promoting antimicrobial stewardship. The culture of undiagnosed prescription of antibiotics is a big contributor to bacterial resistance. The lack of public awareness about the issues has led to the continued over-prescription and unnecessary use of medicine. However, as a nurse practitioner, I have the responsibility of sensitizing patients about the dangers of unnecessary usage of these medications and also only prescribe antibiotics only upon diagnosis. The experience with the upper respiratory tract infection patient will make me a better nurse practitioner.
References
Castro-Sánchez, E., Gilchrist, M., Ahmad, R., Courtenay, M., Bosanquet, J., & Holmes, A. H. (2019). Nurse roles in antimicrobial stewardship: lessons from public sectors models of acute care service delivery in the United Kingdom. Antimicrobial Resistance & Infection Control , 8 (1), 162.
Pollack, L. A., & Srinivasan, A. (2014). Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clinical Infectious Diseases , 59 (suppl_3), S97-S100.
Thomas, S., Richards, E.P., Van Winkle, J.W., Ward, T.T., & Leggett, J.E. (2013). Judicious use of antibiotics: a guide for Oregon clinicians. Alliance Working For Antibiotics Resistance Education.
