Research Project and Literature Review: Antibiotics & Ageism

This report presents a research project exploring two key issues: whether nurses should be allowed to prescribe antibiotics and how ageism affects mental health. The first section examines the current state of nurse prescribing practices, considering the legal framework in Australia, the factors influe...Read More

Running Head: Research Project and Literature Review
Assessment 1
Research Project and Literature Review
Question 1: Should Nurses be allowed to prescribe Antibiotics?

Research Project and Literature Review
Contents
Introduction…………………………………………………………………………………………………………..3
Research Findings………………………………………………………………………………………………….4
Conclusion…………………………………………………………………………………………………………….5
References…………………………………………………………………………………………………………….6
Appendix……………………………………………………………………………………………………………….7
2, <Student Name>, <Email Address>

Research Project and Literature Review
Introduction
The first question used for research is ‘Should Nurses be allowed to prescribe Antibiotics?’ As per the
Health Practitioner Regulation National Law Act, the Registered Nurses are liable to prescribe the
scheduled medications on meeting the requirements of Registration standards (Nursing and Midwifery
Board of Australia [NMBA], 2017). Last year, NMBA proposed an endorsement for Registered Nurses to
allow them prescribe medications alongside GP and NP. The proposal was opposed by RACGP due to
concern that it would enhance the fragmentation of care and would have more adverse outcomes than
the benefits (Ness, Malcolm, McGivern & Reilly, 2015).
Inappropriate prescription of antibiotics is a problem. It increases the antimicrobial resistance. So it is
important to explore the prescribing attitude and behavior of nurses.
In Primary Care Settings, 80% of the antibiotic prescriptions take place (Ness, Malcolm, McGivern &
Reilly, 2015). The RNs mostly prescribe pain medications and antibiotics for treating infection and other
injury related issues. The question was chosen due to curiosity to find out medical and ethical
considerations behind this practice.
3, <Student Name>, <Email Address>

Research Project and Literature Review
Research Findings
Structural literature search was conducted using keywords ‘Nurse Prescribing Antibiotic’, ‘Nurse
Prescribing Australia’,’ Registered Nurse, antibiotics and Australia’. Database CINAHL and Medline was
searched for journals from 2012- 2019. Data was collected on the basis of factors influencing the
authority of nurses for prescribing antibiotics.
Research question has been explored and answered by many evidence based literatures. The research
was time effective and explored diverse set of knowledge and skills in nursing. It is worth refining the
question to examine the depth of antibiotics prescribing practice among nurses in Australia.
Fong (2017) identified multiple practices of Nurse Practitioners prescribing in Australia however very
little is known about prescriptions by Nurses in critical care units. The nurses are responsible for 8%
antibiotic prescriptions in Primary care as they frequently manage the patients (Courtenay, 2019).
Courtenay et al (2019) stated that several factors affect nurse prescribing antibiotics such as knowledge,
skills, beliefs about capabilities, professional role, environmental context, self monitoring behavior,
patient expectations and behavioral regulations.
Ness,Price,Curie & Reilly (2016) found that Antibiotic prescribing behavior of nurses is influenced by
protocols, guidelines, safety, efficacy and tolerability of medicine, the experience and training of nurses
and patient pressure. However, in most cases the nurses feel diagnostic uncertainty while prescribing
the antibiotics.
Latter & Smith (2012) found that the nurses generally make medically appropriate decisions in
antibiotics prescriptions. The decisions qualify the ten (Medication Appropriateness Index) MIA criteria
namely effectiveness, indication, dosage, practicality, directions, drug disease interaction, drug-drug
interaction, cost, duration and duplication. Still there is scope of improvements in terms of diagnostic
skills and cost of drugs.
As per the findings of Ness, Malcolm, McGivern & Reilly (2015), since 2007, the number of antibiotic
prescriptions by the nurses has increased as first line of infection treatment. Moreover, the quality of
prescriptions has also improved. Qualified, suitably trained and experienced nurses should be able to
prescribe antibiotics. Nurses as supplementary prescribers, community practitioner nurse prescribers
4, <Student Name>, <Email Address>

Research Project and Literature Review
and independent nurse prescribers have rights to prescribe any drugs whether (licensed or unlicensed)
under their competence, to prescribe antibiotics.
Nurses spend most of the time with the patients so they may play significant role in optimizing
antibiotics prescriptions. In Australia, the antibiotics are prescribed for respiratory infections 4-9 times
more than the recommended guidelines. The Nurses play an important role in preventing infection.
They can control the antibiotic resistance through their prescribing behavior. There are Antimicrobial
Stewardship Clinical Care Standards for guiding the nurses in terms of timeliness of antibiotic
administration, documentation, patient education and route of medication administration
(Commonwealth of Australia, 2019). There are specified recommendations for informing the role of
Nurse Practitioners in prevention of Antimicrobial Resistance.
In Australia, the Prescriber Nurses have to meet the requirements under National Law section 109, to
qualify the professional development competency for prescribing the medications. Anti-infective drugs
and analgesics are the most commonly prescribed medicines in Australia. In Australia, there are policy
and legislative barriers in Nurse Practitioner’s prescribing practice such as Access to Pharmaceutical
Benefits Scheme (PBS). The legislative reforms enable the Nurse Practitioners to be eligible for the
reimbursements of PBS.
Research suggests that in comparison to US, Canada and UK, the NP prescription in Australia is still in
infancy. There are no literatures of assessments related to NPs prescribing practices in Australia. Further
reforms are needed in policies and regulations at national level to make the Nurse Prescription a reliable
practice.
Conclusion
The involvement of Nurses Practitioners in Antibiotic Prescriptions has improved for the last decade
however the main force behind this practice is to fulfil the needs of underserved populations in remote
areas where there is scarcity of GPs. Regulations, and educational expertise of Nurses varies greatly
across different countries, however there is demand of greater educational expertise for writing
antibiotic prescriptions by the nurses. A further improvement in terms of quality, education, and
expertise is essential for the nurses to be eligible for prescribing sensitive medications like antibiotics.
5, <Student Name>, <Email Address>

Research Project and Literature Review
References
Courtenay, M., Rowbotham, S., Lim, R., Peters, S., Yates, K., & Chater, A. (2019). Examining influences on
antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the
Theoretical Domains Framework and COM-B. BMJ open, 9(6), e029177.
doi:10.1136/bmjopen-2019-029177
Commonwealth of Australia (2019). Nurses and Antimicrobial Resistance (AMR) fact sheet. Retrieved
from https://www.amr.gov.au/resources/nurses-and-amr
Fong,J., Buckley,T., Cashin,A. & Pont,L.(2017). Nurse practitioner prescribing in Australia: A
comprehensive literature review. Australian Critical Care. 30(5). 252-259.
Latter,S., Smith,A., Blenkinsopp,A., Nichols,P., & Little,P.(2012). Are nurse and pharmacist independent
prescribers making clinically appropriate prescribing decisions? An analysis of consultations. J
Health Serv Res Policy. 17(3):149-56. doi: 10.1258/jhsrp.2012.011090
Ness,V., Price,L., & Currie,K.(2016). Influences on independent nurse prescribers' antimicrobial
prescribing behaviour: a systematic review. J Clin Nurs. 2016 May;25(9-10):1206-17. doi:
10.1111/jocn.13249
Ness,V., Malcolm,W., McGivern,G., & Reilly,J.(2015). Growth in nurse prescribing of antibiotics: the
Scottish experience 2007–13. Journal of Antimicrobial Chemotherapy, 70(12), 3384–3389,
DOI: https://doi.org/10.1093/jac/dkv255
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Research Project and Literature Review
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Research Project and Literature Review
8, <Student Name>, <Email Address>