A survey of nurse practitioners (NP) found almost all appreciate the risks of antibiotic resistance (AR) and most were confident of their ability to prescribe antibiotics appropriately, a recent study showed.

More than 170 NPs at a large university-affiliated healthcare system in the northeast took part in the survey and 95 percent agreed or strongly agreed that they intend to follow evidence-based guidelines when prescribing antibiotics.

While nearly 80 percent of the NPs said prudent antibiotic prescribing is a priority for their team, roughly 38 percent either agreed or were neutral about whether antibiotic prescribing practice should follow the preference of the senior clinician. And about 70 percent said that concern about patient deterioration or complications can lead them to prescribe antibiotics, but only 15 percent said patient or family expectations cause them to use them when not clinically indicated.

More than half the respondents agreed that they need more education and feedback on antibiotic prescribing, perhaps not surprising since around the same percentage said they prescribe antibiotics less than a quarter of the time in daily practice.

The survey also allowed for open-ended responses and most of th0se 18 respondents commented on instances where they defer the prescribing decision to someone else:

• NPs are not permitted to order antibiotics in my clinical setting.
• Work with attending physicians that make final decisions on my admitting orders.
• Never prescribe antibiotics. I refer to primary care provider or infectious diseases.
• We consult Infectious Disease specialists to collaborate and guide antibiotic decisions in critical care.

Two others, however, suggested such deferral was not ideal:

• I wish that antibiotic stewardship was emphasized across the board. I work with a physician who routinely has patients on antibiotics for longer than the recommended duration. I am constantly trying to re-educate her patients and adjust their antibiotic prescriptions.
• Physicians often dictate the use, and they all prescribe something different with seemingly no evidence-based practice.

Two respondents commented on how they believed their NP training did not dedicate enough time to antibiotic-prescribing practices.

The study’s authors note, however, that more experienced NPs both expressed greater confidence in prescribing antibiotics and were less likely to ask a physician or pharmacist for advice. They also saw less need for additional education on the topic.