Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship

Abstract

Background: Antibiotic stewardship (ABS) is a set of strategies to optimize the use of antibiotics with the goal of reducing antibiotic resistance, improving patient outcomes and decreasing unnecessary costs. ABS affects all venues of patient care, including outpatient, inpatient, and long-term care. While many strategies for ABS exist and best practice continues to evolve, successful ABS programs utilize a multidisciplinary approach. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. The purpose of this study is to describe the knowledge, attitudes, and perceptions of NPs towards ABS. Methods: A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey developed for use in a previous study conducted at a university-affiliated hospital in Florida. Descriptive statistics were used to assess normality. Chi-Square test of independence was used to test differences categorical scores by NP setting, gender, and level of education. Pearson r correlation was completed to measure the relationship between age and years in practice. Results: Two hundred NPs completed the questionnaire (88% female; 70% Master's degree). The range of experience was 0-45 years (mean 11 years). Most NPs worked in a private office (23%) or community setting (29%). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). NPs in this study also based their antibiotic decisions on the antibiogram (63%) in their setting, while 56% indicated they start with broad spectrum and tailor antibiotic choices when culture results are received. NPs reported understanding that inappropriate use of antibiotics causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important for their job (94%) and felt confident in their use of antibiotics (86%). However, while 94% of respondents somewhat or strongly agreed that antibiotics are overused nationally, only 62% thought antibiotics were overused in their health care setting. Conclusion: In this study, most NPs reported that antibiotic resistance is a problem and antibiotics are overused nationally. Fewer believe that antibiotic resistance is a problem locally and fewer still that they, personally, contribute to the problem. NPs recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.

Knowledge and Attitudes about Antibiotics and Antibiotic Resistance of 2404 UK Healthcare Workers

“…It is important that prescribers understand the wider implications of AMR on patient outcomes. The positive results in the knowledge test correlate with earlier studies; in the United States, Hamilton et al found that 97% ( n = 194) of nurse practitioners understood antibiotics can harm the patient and inappropriate use can cause resistance (97%) [ 11 ].…”

“…Evidence also exists for a subset of medical prescribers and nurses. Earlier studies have reported good knowledge of antibiotics among nurse practitioners and their intention to prescribe antibiotics appropriately [ 11 , 12 ]. Factors impacting nurse and physician prescribing have included patient pressure, fear, complacency and time [ 12 , 13 ].…”

“…Factors impacting nurse and physician prescribing have included patient pressure, fear, complacency and time [ 12 , 13 ]. Although there is some evidence for medical prescribers and nurses, a gap remains in the literature regarding multidisciplinary HCWs’ knowledge, attitudes and behaviours towards this topic [ 11 , 12 , 13 , 14 , 15 ].…”

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

“…207 infection preventionists (IPs) working in acute care hospitals (1) Leadership support of nurses’ involvement in antibiotic stewardship; (2) Nurses’ performance in antibiotic stewardship activities; (3) Nurses’ knowledge and training in antibiotic stewardship The survey consisted of 40 multiple-choice and free-text questions Study findings indicate the need for nurse leaders to improve the preparation and integration of clinical nurses in ASPs. While clinical nurses routinely perform activities that contribute to optimal antibiotic use, the knowledge and competency of clinical nurses in these activities and their formal integration in ASPs are minimal Hamilton et al [ 22 ] Utah (USA) Cross-sectional study The 2018 annual American Association of Nurse Practitioners (AANP) conference in Denver, Colorado Describe the knowledge, attitudes, and perceptions of NPs about antibiotic use, resistance, and stewardship NPs. 194 NPs completed the questionnaire.…”

Knowledge and Attitudes about Antibiotics and Antibiotic Resistance of 2,404 UK Healthcare Workers

“…Although studies and public health campaigns that investigate and target the general public's knowledge and understanding of antibiotics and antibiotic resistance have been conducted [7,8], and there is some evidence for medical prescribers and nurses, a gap remains in the literature regarding multidisciplinary HCW's knowledge, attitudes and behaviours on this topic [9][10][11][12][13].…”