Ways of Stopping Inappropriate and Unnecessary Prescription of

STOPPING PRESCRIPTION OF ANTIBIOTIC FOR RESPIRATORY INFECTION 19

Antibiotic for Respiratory Infection

Bethzaida V. Linga

Dr. Krista Krause

October 21, 2014

Inappropriate and Unnecessary Prescription of Antibiotic forRespiratory Infections

Research has indicated that more than half of respiratory infectionsare as a result of viruses. The various respiratory infections thatclinicians prescribe antibiotics for include but not limited to sorethroat, sinusitis, ear infection, bronchitis and upper respiratoryinfection. Some of these respiratory infections do not need theprescription of antibiotics and therefore medical experts argue thattheir prescription is more than what is necessary. In the UnitedStates alone, over 11 million antibiotic prescription to children andminors are unnecessary and sometimes harmful (Beracochea et al.,2011). Antibiotics are only useful in cases where the infections arecaused by bacteria. Unfortunately, the majority of the respiratoryinfections are viral, and therefore antibiotics are prescribedunnecessarily and inappropriately.

The American Academy of Pediatrics published a study conducted by Dr.Matthew Kronman, which highlighted how antibiotics areinappropriately and unnecessarily prescribed to young children andteens. The research found out that there are 57% antibioticprescriptions for all respiratory infections reported (Beracochea etal., 2011). However, the study also discovered that out of the 57%prescriptions, there are only 27% infections that are caused bybacteria. In this regard, it is evident that there are more than halfantibiotics prescriptions that are unnecessary

Clinical Excellence

Nurses have the responsibility of ensuring that they deliver the bestquality care to their patients. Clinical excellence, according to theNational Health Service, is ensuring that clinical officers andnurses offer the best possible quality care to patients. Healthprofessionals must be in the frontline in educating the members ofthe public on the dangers of unnecessary prescription of antibiotics.More often than not, health care providers do not have the equipmentthat can determine whether a respiratory infection is a viral or abacterial disease. Therefore, it is inevitable that the nursepractitioners end up prescribing antibiotics even in cases where theyare not needed.

Inappropriate and unnecessary prescription of antibiotics forrespiratory infections has long term side effects and is also costly.The development of antibiotic resistant infections has widely beenblamed on these unnecessary prescriptions. There are instances wherehealth professionals argue that they do not have sufficient time todo all what is required to offer quality care to a patient. As aresult, cases of inappropriate prescriptions occur, and the sideeffects are dire. According to the National Healthcare SafetyNetwork, healthcare providers, administrators, patients and thegovernment policy makers have a role to play in ensuring clinicalexcellence (Beracochea et al., 2011).

The healthcare providers must provide the necessary and correct carefor carrying out the relevant tests. They must ensure that patientsare given the right drugs and the right dosage. The healthcareproviders must also reassess the antibiotic prescriptions after 48hours on the basis of the tests they carried out and the patientexamination. In order to attain clinical excellence, it is prudentfor the healthcare providers to keep a record of the antibiotic’sdosage and duration in their healthcare facility. All the nursepractitioners must work in the realm of respect for patients,generosity and doing justice (Slawson et al., 2012). These areethical standards that are essential for providing holisticpatient-centered healthcare. Justice in the healthcare profession isan obligation upon the healthcare providers to offer quality careaccording to the law. Respect for patients encompasses doing what isgood for the patients and avoiding harming the patient. Generosity onthe hand requires the healthcare provider to offer quality andpatient-centered care according to the established morals. All theabove three ethical principles must be put in place in order toprovide quality patient-centered healthcare services. Clinicalexcellence is also achieved through collaboration, consultation, andcontinuous education. It is also imperative for the healthcareproviders to have self-reflection sessions.

The healthcare center administrators have the responsibility ofdeveloping a working feedback system from the patients. This shouldbe aimed at ensuring that the nurses and or the health professionalscan attain excellence over time. Unnecessary and inappropriateprescription of antibiotics or over prescription of antibiotics hasnumerous side effects. Beside the development of antibiotic-resistantbacterial infections, the ailing patient may suffer and can alsoinfect other people (Slawson et al., 2012). It is evident that withproper prescription of antibiotics for respiratory infections, theside effects of unnecessary and inappropriate prescriptions will beavoided.

A Model for Change

Various national health institutions provide information regularly onhow to improve healthcare provision to the people. For the case ofunnecessary and inappropriate prescription of antibiotics forrespiratory infections, there are various models of change that canbe adopted to alleviate the problem. Research has indicated that theproblem is fueled by the lack of awareness and health information toboth the clinical nurses and the patients (Chambers et al., 2013).Majority of patients with viral respiratory infections insist onbeing given a dosage of antibiotics. In the entire of Europe,antibiotic awareness campaigns are carried out every year. This isaimed at educating the public and the whole healthcare industry onthe dangers of a wrongful prescription of antibiotics.

The awareness campaign, which is supported by Department of Healthand its Advisory Committee on Antimicrobial Resistance and HealthcareAssociated Infections, has achieved tremendous success in reducingcases of inappropriate antibiotics prescription. The CDC`s NationalHealthcare Safety Network has come up with various strategies thatcan be used to deal with this problem.

Antibiotic Stewardship Programs

These are programs that can be adopted in the healthcare facilitiesor outpatient settings like clinics to deal with the issue of thewrongful prescription of antibiotics for respiratory infections. Inorder to achieve the outcomes of the program, it is prudent toappoint a leader for accountability purposes. Research has indicatedthat physicians can offer the best leadership for antibioticstewardship programs. It is imperative to ensure that the program hasenough resources, human resource personnel, and the necessaryinformation technology equipment (Chambers et al., 2013).Prescription improvement actions such reassessment after 48 hoursmust be incorporated into the program to ensure its success.

Tracking of the various trends of prescribing and antibioticresistance cases is essential in order to take the necessary action.The patterns obtained from the tracking must be communicated to thestaff in order to come up with ways of improving. The program alsoencompasses education to the staff on improving the prescriptionpractices, as well as about antibiotic resistance (Slawson et al.,2012). It is also vital to work with other healthcare facilities toavoid further infections and or transmissions.

Theoretical Model and Framework

Community Health Promotion Model

Promoting healthy practices amongst the community is one of the bestmodels to address the problem of unnecessary prescription ofantibiotics for respiratory infections. There are numerous caseswhere the patients are the ones who insist that the nursepractitioner should prescribe a particular antibiotic for theirillness (Slawson et al., 2012). However, the patient might be unawarethat the ailment does not need an antibiotic. Additionally, it isevident that the majority of patients purchase antibiotics, or storeantibiotics that prescribed to them for future use. Equally, thereare patients who use antibiotics that were prescribed for otherpeople whom they assume have the similar illness as theirs.

It is, therefore, extremely necessary to educate the populace on theproper ways of using antibiotics. This will help in reducing thenumerous cases of antibiotic-resistant bacteria. It is vital toeducate the public on taking the preventive measures by following theprescription and dosage directives from the health professionals.

Step 1: Assess the Need for Change in Practice

Problem

The primary aim of this model is to offer preventive measures asopposed to curative measures. The public must be educated on thedangers of unnecessary prescription on a timely manner to avoid thediscussed side effects. However, there is always the problem ofreaching the entire population. There are people who are unreachableand therefore the problem of antibiotic resistant bacteria continues.The cost of educating the public about antibiotic resistance andover-prescription, as well as inappropriate prescription is a majorhindrance.

Intervention

The use of health practitioners at health facilities will enabletransmission of knowledge to the patients suffering from respiratoryinfections or antibiotic-resistant bacterial infections. It iscritical for the nurses at the health facilities to offer educationto the patients about antibiotic prescriptions (Beracochea et al.,2011). Provision of the right antibiotics is also essential to ensurethat the patients are offered quality patient-centered healthcare.The health practitioners must also offer advice to the patient on thevarious healthy lifestyles and the measures to take to avoidover-prescription, unnecessary prescription or antibiotic resistance.

Goals

The healthcare providers must set goals for patients practicing overprescription of antibiotics or patients who are taking antibioticsunnecessarily. The providers can set out activities that involveproper prescription of antibiotics to a patient by a healthpractitioner.

Step 2 Locating the Best Evidence

Literature Review

Antibiotics are powerful medicines used to treat humans and animals.The importance of antibiotics cannot be underestimated because withproper administration of antibiotics most bacterial infections anddisease can be adequately treated. Antibiotics kill bacteria or keepthem from reproducing. However, antibacterial cannot kill viruses ortreat infections caused by viruses. These are diseases such as colds,bronchitis, flu and sore throats unless caused by strep. Improper useof antibiotics is very dangerous to a person’s health,inappropriate administration of antibiotics leads to bacterialresistance to common antibiotics. Therefore, a person should alwaysensure that the finish their medicine even when they feel better. Itis also necessary to take the medicines as prescribed by apharmacist. Failure to take antibiotics can make a person getinfections that antibiotics cannot cure. Methicillin-resistanceStaphylococcus aureus (MRSA) causes infections that are resistant toseveral common antibiotics.

Methods

Search Strategy on the evidence on the effect of inappropriateadministration of antibiotics for respiratory diseases.

According to a study recorded in the Journal of American MedicalAssociation it was found that doctors are prescribing antibiotics tochildren more frequently than is necessary. Researchers at Brighamand Women`s Hospital and Harvard Medical School compared the rate ofantibiotic prescriptions for sore throats to the rate of testing forgroup A B-hemolytic streptococci (GABHS) or strep throat. Thesebacteria are responsible for 15% to 36% of sore throats in children.The researchers used data collected from 1995 to 2003 as part of theUS National Ambulatory Medical Care Survey and the National HospitalAmbulatory Medical Care Survey. It was found out that antibioticswere prescribed in 48% of visits where doctors tested for strep and51% of visits where no test was done. A statistical analysis found norelationship between testing and the likelihood of receiving aprescription for antibiotics (Dr. Jeffrey A. Linder et al,).

Step 3 Critically Analyze the Evidence

According to the evidence presented in the Journal of AmericanMedical Association there is an urgent need for intervention andawareness campaign on proper administration of antibiotics bydoctors. On the other hand, patients should also be aware of thedangers they put themselves when they take antibioticsinappropriately. The good news from the research done by the Journalof American Medical Association, statistical data from the reportsuggests that there is a decrease in the improper administration ofantibiotics (Dr. Jeffrey A. Linder et al, ). There is also anencouraging report due to advancement technologies there are nowantibiotics that are easier to administer to the patient due to theirmore convenient dosing schedule. In other modern antibiotics, theperiod required to complete a full treatment is short, therefore,there is total uptake of the medicine by patients (Levy RA.)

There is also an excessive administration of antibiotics to patients.According to the Centers for Disease Control and Prevention (CDC),antibiotic prescribing in outpatient settings could be reduced bymore than 30 percent without adversely affecting patient health. Someof the reason cited for this negligence are too much pressure on thedoctor and demand for quick recovery by patients.

Step 3Feasibility, Benefits, and Risk

Feasibility evaluates and analyzes the potential of the proposedproject based on the extensive research to support decision making.The model proposed above is logical and feasible since it takes intoaccount all the affected healthcare groups in the society. Theinclusive nature of the model gives it an edge since it is acceptableand sits well with the general patient population. The healthcareorganization especially outpatient settings would adopt this modelsince all parties stand to benefit.

Measures taken to stop inappropriate prescription of antibioticsfor respiratory diseases

The FDA and CDC have launched a nationwide antibacterial campaign soas to reduce the demand and oversubscription of antibiotics. Theyhave developed a nationwide ad campaign to emphasize to the healthcare professionals on the prudent use of antibiotics. The FDA and CDCalso offer educational brochures teaching them on the proper use ofantibiotics. In 2003, the FDA published a rule that requires specificlanguage with human antibiotics with labels to encourage doctors touse them when only necessary and to counsel their patients on theproper use of these drugs.

Scientists and health professionals are in agreement that the way todecrease antibiotic resistance is through more cautious use ofantibiotic drugs and monitoring outbreaks of drug-resistantinfections. Research on the various mechanisms through which bacteriaevade drugs is steadily undertaken. The FDA`s National Center forToxicological Research (NCTR) is studying the mechanisms ofresistance to antibiotic agents in bacteria.

A case study on the impact of improper administration of antibioticspublished in the Journal of American Medical Association was able toshow benefits of proper administration of antibiotics. In this study,key factors on that are entailed in administration of antibioticswere identified. A multifaceted approach was used. Household andoffice-based patient education materials and a clinician educationalassistance were made available. The following information was sent to25,000 households:

Information about self-care and prevention against diseases. When toseek care and what to expect from hospital visits for colds, flu, andbronchitis diseases

A pamphlet produced by CDC on the proper use of antibiotics.

A pamphlet addressing proper hand washing techniques

A letter announcing a campaign to combat antibiotic resistance byreducing unnecessary antibiotic use

At the doctor’s office there were posters attached to the wall ofeach room, with information on the limited role of antibiotics inacute bronchitis or chest colds for patients.

There was also a complete doctor and nurse education trainingprogram. All adults ailing bronchitis, sinusitis or upper respiratorytract infection who came to the clinic for medication were put understudy.

It was found that proper use of antibiotics led to a decline in thenumber of patients returning for repeat treatment of same disease (RGonzales et al, nd)

Benefits

The most significant benefit of the ways of stopping inappropriateand unnecessary prescription of antibiotic for respiratory infectionswould be the realization of a healthy and antibiotic free society. Itwould be as an outcome of the combined effort of the government, thehealth care institutions, and the society. These can be easilyimplemented by each healthcare provider, and patients play theirpart. It would also largely reduce the antibiotic resistanceinfection and cost of treatment.

Risk

The downside of the proposed model would be the cultural acceptanceamong the people. Not all patients would be willing to accept the newnorm, and would risk failure. It also propagates a particular kind ofbureaucracy whereby hospitals would charge so highly for treatmentand sophisticated testing.

Just like with all medicines, antibiotics have a number of sideeffects, and risk when prescribed inappropriately and unnecessary.Most side effects of antibiotics are not life threatening. The commonside-effects of antibiotics include: diarrhea and mild stomach upsetsuch as nausea. Antibiotics can kill beneficial bacteria that live inthe vagina and bowels. This bacteria helps in digestion and fight offinfectious bacteria. Some antibiotics may also react withcontraceptives making them ineffective. These are antibiotics thatcontain rifampicin. (Dr. Tim Kenny)

Design of awareness and preventive program

The issue of unnecessary prescription of antibiotics requires adesign that will ensure that the public, the government and thehealth practitioners are fully involved in stopping the unnecessaryprescription of antibiotics for respiratory infections. Thegovernment should come up with an awareness campaign that is designedin such a way that the public and the health practitioners are awareof the dangers of unnecessary prescription of antibiotics fornon-bacterial infections such as respiratory infections which areviral infections. The prevention and the awareness campaigns shouldbe emphasized during the flu seasons when the majority of the peopleabuse antibiotics.

The government should organize seminars for nurses and other healthofficials where they are trained on the dangers of unnecessaryprescription of antibiotics for non-bacterial infections. It is vitalto equip the nurses with sufficient knowledge that will enable themeducate the public about the effects of the use of inappropriate ofuse of antibiotics. Te program should be designed in such a way thatthe all the health practitioners are made aware of the government’sintention to control the prescription of antibiotics fornon-bacterial infections. Training programs should be made compulsoryfor all the health practitioners and divided into regions across thecountry. The health practitioners can attend the training sessions inshift such as morning session and evening meetings.

The government must put in place sufficient trainers across thecountry who will ensure that the training is successful. The nursesand the health practitioners will in turn train the members of thepublic who seek medical attention asking for antibiotics for viralinfections. Well-designed brochures and televised advertisements willalso be used for informing the people on the dangers of inappropriateand unnecessary prescription of antibiotics. This plan is aimed atensuring that the information regarding the use of antibioticstrickles down from the government trainers down to the healthpractitioners and finally to the members of the public.

The television, radio and print advertisements must be clear and havea direct message to the public. It is essential to haveadvertisements that are clear to the public in order o ensure thatthe message is understood. The advertisements should be played duringthe prime time such in the middle of the news or in the midst of afavorite program. It is critical to have posters and signboardsdiscouraging the use of antibiotics without prescription by a healthpractitioner. The posters and signboards should be placed in areaswhere there are numerous people such as in town centers and areaswhere there are schools. The design of the program will also involvethe church leaders who will be in a position to distribute brochuresand inform the members about the dangers and effects of unnecessaryand inappropriate prescription of antibiotics for respiratoryinfections.

The design seeks to involve all the stakeholders in the healthsector. The key aim of the program is to inform the members of thepublic who seem to prefer antibiotics for viral infections (NIH,2011). It is evident that reaching all the people including the onesin remote areas is extremely difficult and therefore church andreligious leaders will ensure that majority of the people in theremote areas get the information.

Implementation and evaluation

The implementation and evaluation of the awareness and preventionprogram will require a enormous amount of resources, as well aspersonnel. The government must hire numerous experts who will act astrainers to the nurses and the health practitioners. It is alsoessential to have sufficient resources to implement an awarenessprogram. It is evident that the advertisements on television, radioand the newspapers, as well as posters, will require adequateresources to fund (Butterfield, 2010). Additionally, the trainersmust be paid, and the organization of the seminars will requirelogistical arrangements with financial requirements. The programshould be implemented in phases with evaluations at every stage toassess the success of the program.

It is essential to have the nurses trained for one month and allowthem to educate the patients and disseminate the information to themembers of the public for one month. At the end of the second month,there should be an assessment of the number of cases that have beenreported of bacterial resistant infections. The number of patientsseeking for antibiotics in health centers should also be clearlyrecorded for purposes of evaluation. When the assessment is beingdone, there will be a clear indication of whether the demand for theantibiotics has reduced or has remained high. In instances where therequest for antibiotics for respiratory infections goes high orremains the same, it will be a clear indication that the programaimed at stopping inappropriate and unnecessary prescription ofantibiotics for respiratory infections has not succeeded (Grinspun,2011). However, when the results indicate that the demand forantibiotics has gone down and or the rates of antibiotic-resistantbacterial diseases have reduced, it is an indication that the programis successful and should continue.

The need for implementing the program in phases is to ensure that thenecessary changes are done to the program to ensure that maximumbenefits are achieved. For instance, the choice to include otheravenues of creating awareness would be done in the second or thethird phase. Such other-awareness would be the social media platformssuch as Facebook and Twitter where an enormous number of the youthscould be informed about the dangers of unnecessary use of antibiotics(AARC, 2012). The implementation and evaluation process should be acontinuous process that seeks to stop the unnecessary andinappropriate use of antibiotics for respiratory infections such asflu and sinuses. Evaluation is vital for this program as it willindicate the success or the failure of the program, as well as giverecommendations for any changes that might be needed.

Integration and maintenance

There needs to be an office that is dedicated to the integration ofthe production. The office will facilitate the implementation of theprogram across the country. The office will also be tasked with theresponsibility of allocating funds to the various functions of theprogram implementation. Integration will ensure that the program isboth efficient and effective. Additionally, integration will be toensure the consistency and maintenance of the program. The policiesfor the program will be integrated with the field activities at theoffice of integration for the awareness program. Integration of theprogram will also oversee the supervision and assessment of theprogram’s effectiveness and success.

The integration office of the awareness program will also ensure thatthe regional offices will follow the program plans for efficient useof resources and allocation of staff. Integration of the program willalso ensure that the all the stakeholders in the health sector arebrought together under one umbrella for the efficient implementationof the awareness program (AHRQ, 2014). The government, healthpractitioners and the members of the public must be brought togetherfor the purposes of the successful implementation of the program. Itis essential for the program to be integrated into the healthcaresystem as part of the service to the patients. Nurses and otherhealth practitioners must be instructed always to inform the patientsof the effects of unnecessary use of antibiotics for respiratoryinfections

The maintenance of the program will largely depend on the successfulimplementation and integration of the program. There needs to be acontinuous flow of funds to finance the operations of the program.The government will be the largest funder of the program. It is alsoessential to have donors supporting the program to ensure itsmaintenance and success. Prudent use of the resource and thedistribution of staff will also ensure that the program is efficientand therefore maintainable. The program plan needs to be followedstrictly to ensure that the allocated resources are not misused. Theinvolvement of all the stakeholders will ensure that the program issustainable. It is also essential to have assessments at every phaseto ensure that there are successes recorded. The success of theprogram will attract donors who will fund the project and ensure itsmaintenance.

Conclusion

The fight against improper prescription of antibiotics forrespiratory diseases is a challenging and complex war. This isbecause the doctors, as well as other health care providers, and thepatients need to be educated on the proper use of antibiotics. Thedecrease in the rate of improper prescription of antibiotics showsthat there is hope for appropriate use of antibiotics in the future(Dr. Jeffrey A. Linder et al., nd). However, we are still far fromthe desired position, and more efforts need to be done.

References

AHRQ`s Efforts to Prevent and Reduce Health Care AssociatedInfections. (n.d.). Retrieved October 23, 2014, from http://www.ahrq.gov/research/findings/factsheets/haiflyer/index.html

Beracochea, E., Weinstein, C., &amp Evans, D.P. (2011).&nbspRights-basedapproaches to public health. New York:Springer Pub. Co.

Blaser, M. (n.d.). Missingmicrobes, how overuse of antibiotics is accelerating modern plagues. (1st Ed.).

Cunha BA. (1998). The importance of compliancewith oral antibiotic regimens. Advancesin Therapy.

Chambers, R., Wakley, G., &amp Blenkinsopp, A.(2013). Supporting self-care inprimary care. Abingdon: Radcliffe

High rates of unnecessary prescribing ofantibiotics. (2013, October 3). Retrieved October 23, 2014, fromhttp://www.sciencedaily.com/releases/2013/10/131003121256.htm

Lieberman, P. (n.d.). Astrategic plan to preserve the impact of antibiotics.Retrieved October 23, 2014, fromhttps://www.cspinet.org/reports/abiotic.htm

Lim, F. (n.d.). Whatnurses need to know about the resistance of antibiotics.Retrieved October 23, 2014, fromhttp://www.minoritynurse.com/article/what-nurses-need-know- about-antibiotic-resistance

Slawson, D., Shaughnessy, A., &amp Ebell, M.(2012).&nbspEssentialEvidence: Medicine That Matters.Hoboken: John Wiley &amp Sons.

R Gonzales et al. (1999). Decreasing antibioticuse in ambulatory practice. Impact of a multidimensionalintervention on the treatment of uncomplicated acute bronchitis in adults: Journal of American MedicalAssociation.

Southwick, F. (2008). Infectiousdiseases: A clinical course (2ndEd.). New York: McGraw- Hill Medical.

Wilson, L. (2012, April 1). Beyond Antibiotics.Retrieved October 23, 2014, from http://www.drlwilson.com/articles/antibiotics.htm

CMS. (2014). Center for Medicare and Medicaid service.Retrieved from: http://www.cms.gov/site-search/search-results.html?q=antibiotic

NIH. (2011). Commonlyprescribed antibiotic reduces acute COPD attacks.Retrieved from: http://www.nhlbi.nih.gov/news/press-releases/2011/commonly-prescribed-antibiotic- reduces-acute-copd-attacks

AARC. (2012). InfectionControl in Respiratory Care.Retrieved from: https://appserver.aarc.org/WEB/Online/Online/Events/Event_Display.aspx?EventKey=W C012815&ampWebsiteKey=2a643220-66d7-4703-bb07-b2e08e54b190

Grinspun, D. (2011). Letterto Niagara Health System re: C. difficile outbreak.Retrieved from:http://rnao.ca/policy/submissions/letter-niagara-health-system-re-c-difficile- outbreak

Butterfield, S. (2010). Futureof antibiotics worries infectious disease experts.Retrieved from: http://www.acphospitalist.org/archives/2010/01/idsa.htm