Influences on independent nurse prescribers' antimicrobial prescribing behaviour: a systematic review

Aims and objectives To present the findings of a systematic review which explored the influences on the antimicrobial prescribing behaviour of independent nurse prescribers. Background Antimicrobial resistance is an urgent public health concern and inappropriate antibiotic prescribing is linked to an increase in this resistance. With a growing number of nursing staff potentially prescribing. Design A systematic review. Methods A comprehensive search strategy was employed to identify appropriate research papers. Results were screened for relevance using eligibility criteria, and the assessment of the methodological quality of the papers was conducted using a critical appraisal tool. Results Seven studies were found which explored influences on nurse prescribers' antimicrobial prescribing behaviour. Three of these expected that an antimicrobial would be given and therefore influences discussed were on the choice of the antimicrobial given. Guidelines/protocols, safety, tolerability and efficacy of the antimicrobial itself, patient/parent pressure and training/experience were mentioned as influencing factors within the reported studies. The other four studies explored influences on whether to prescribe an antimicrobial or not and also found that guidelines/protocols were an influencing factor, however, the influence occurring most frequently was diagnostic uncertainty. Conclusions The studies were limited by methodological issues and therefore further research is recommended to explore all influencing factors on prescriber behaviour. Relevance to clinical practice: It has been recommended that interventions to change healthcare professionals' behaviour must be based on theory‐based research. Future research should therefore focus on the use of sound theoretical frameworks in the planning of the studies if we are to be able to understand and, if required, change nurses' behaviours.