Evaluation of nursing' antimicrobial prescribing practices and use in selected public primary health care facilities in the North-West Province, South Africa

Abstract

Background: Antimicrobial Resistance (AMR) poses a significant threat to global health, primarily driven by inappropriate antimicrobial prescribing practices. This study aims to evaluate the effectiveness of Antimicrobial Stewardship (AMS) activities at the primary healthcare (PHC) level. The primary aim was to evaluate the appropriateness of nurses’ antimicrobial prescribing practices and determine the availability of antimicrobial stewardship activities in PHC settings. Methods: The study employed a mixed-methods approach, analysing 366 prescriptions for appropriateness in Phase 1. Descriptive data analysis was performed using SPSS. In Phase 2, fifteen (15) In-depth interviews were conducted with professional nurses, but only twelve (12) were included for analysis. These were analysed verbatim to derive themes related to their understanding of antimicrobial prescribing practices. A pilot study and cross-checking were conducted to ensure the validity and trustworthiness of the results. Results: The majority (89%, n = 326) of the prescriptions were deemed inappropriate. Identified issues included incomplete diagnoses (65%, n = 211) and unjustified use of antimicrobials (7%, n = 23). The identified matters included undocumented dose strengths (86%, n = 438), incorrect dosing (10%, n = 34), and undocumented therapy duration (85%, n = 434) among the 509 prescribed antimicrobials. Qualitative findings revealed six key themes: nurses' understanding of antimicrobial resistance, challenges in antimicrobial prescribing, health education and patient interaction, professional training and confidence, access to resources and guidelines, and awareness of antimicrobial stewardship (AMS). Additional concerns emerged, including the personal use of antimicrobials by nurses and non-adherence to the Standard Treatment Guidelines and Essential Drug List Guidelines, which suggested treatment durations. While some nurses reported clinical support and accessibility to pharmacists, this was inconsistent and often limited to stock management, with the underutilisation of pharmacists for clinical guidance noted. Conclusions: The study concludes that inappropriate antimicrobial prescribing is prevalent in PHC due to systemic and personal challenges that nurses face, potentially contributing to antimicrobial resistance.Recommendations: Key recommendations include expanding the role of Sub-District Pharmacists and infection control practitioners (ICP) to include surveillance, incorporating antimicrobial discussions in pharmaceutical and therapeutics committee meetings, initiating AMS activities at the PHC level, prioritising nurse training on antimicrobials and guidelines, and addressing staffing issues to alleviate workload pressures.