Posted: December 8th, 2014

Ways of Stopping Unecessary Antibiotic Prescription

Order Description

This is the continuation of my Evidenced-Base Practice Proposal. Continue Step 4, 5, and 6.

Book I use is:
Nurse to Nurse Evidence by
Kaplan

————
This week you will submit your entire EBP. Building on Part 1 (continue with the same document; do not submit as two separate documents) you complete Part 2 which includes:

•Step 4 Design

•Step 5 Implementation and Evaluation

•Step 6 Integration and Maintenance

Use Books with Evidenced-Base Practice Project Proposal

Guidelines
Cancer

Agency for Healthcare Research and Quality
American Cancer Society
American Occupational Therapy Association
American Pain Society
American Physical Therapy Association
Cancer Care Ontario
CDC
Centers for Medicare and Medicaid
Institute for Healthcare Improvement
National Chronic Care Consortium
National Comprehensive Cancer Network
National Guideline Clearinghouse
National Heart, Lung and Blood Institute
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission
Cardiac

Agency for Healthcare Research and Quality
American College of Cardiology
American College of Physicians
American Dietetic Association
American Heart Association
American Occupational Therapy Association
American Society for Preventive Cardiology
British Heart Association
CDC
Centers for Medicare and Medicaid
Heart Failure Society of America
Institute for Healthcare Improvement
Institute of Medicine
National Cholesterol Education Program
National Chronic Care Consortium
National Guideline Clearinghouse
National Heart Foundation
National Heart, Lung and Blood Institute
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission
Cardiovascular

Agency for Healthcare Research and Quality
American Association for Thoracic Surgery
American Dietetic Association
American Occupational Therapy Association
American Society for Preventive Cardiology
CDC
National Guideline Clearinghouse
National Heart, Lung and Blood Institute; Peripheral Arterial Disease Coalition
Robert Wood Johnson Foundation
Society for Vascular Nursing
The Joint Commission
CVA

Academy of Neurologic Communication Disorders and Sciences
American College of Physicians
American Occupational Therapy Association
American Physical Therapy Association
Agency for Healthcare Research and Quality
American Dietetic Association
American Heart Association
CDC
Centers for Medicare and Medicaid
Institute for Healthcare Improvement
Institute of Medicine (IOM)
National Chronic Care Consortium
National Guideline Clearinghouse
National Heart, Lung and Blood Institute
National Stroke Association
National Stroke Foundation
NICE (National Institute for Health and Clinical Excellence (NICE)
The Joint Commission

Dementia/Alzheimer’s
American Academy of Neurology
Academy of Neurologic Communication Disorders and Sciences
Agency for Healthcare Research and Quality
American Academy of Neurology
American College of Physicians
American Occupational Therapy Association
American Speech-Language Hearing Association
CDC
Centers for Medicare and Medicaid
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission

Diabetes
Agency for Healthcare Research and Quality
American College of Physicians
American Diabetes Association
American Dietetic Association
American Association of Diabetes Educators
American Occupational Therapy Association
Canadian Diabetes Association
CDC National Diabetes Education Program
Centers for Medicare and Medicaid
American Association of Clinical Endocrinologists
Institute of Medicine (IOM)
International Diabetes Federation
Institute for Healthcare Improvement
National Chronic Care Consortium
National Diabetes Education Initiative
National Diabetes Education Program
National Guideline Clearinghouse
National Institute of Diabetes and Digestive and Kidney Diseases
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission
Gastrointestinal

Agency for Healthcare Research and Quality
American Gastroenterological Association
Centers for Medicare and Medicaid
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
SGNA
The Joint Commission

Infusion
Agency for Healthcare Research and Quality
Home Infusion Nurses Association
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission

Musculoskeletal
Agency for Healthcare Research and Quality
American Academy of Orthopedic Surgeons
American Occupational Therapy Association
American Physical Therapy Association
National Association of Orthopedic Nurses
National Chronic Care Consortium
National Guideline Clearinghouse
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission

Neurological
Academy of Neurologic Communication Disorders and Sciences
Agency for Healthcare Research and Quality
American Academy of Neurology
American Association of Neuroscience Nurses
American Occupational Therapy Association
American Physical Therapy Association
Brain Injury Association
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission
Palliative Care/Hospice

Agency for Healthcare Research and Quality
American Academy of Hospice and Palliative Medicine
American Cancer Society
American College of Physicians
American Occupational Therapy Association
American Physical Therapy Association
Cancer Care Ontario
CDC
Centers for Medicare and Medicaid
Edmonton Zone Palliative Care Program
Hospice and Palliative Nurses Association
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
National Hospice and Palliative Care Organization
National Quality Forum (NQF)
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission

Respiratory
AARC Evidence-Based Guidelines
American Association of Respiratory Care
American College of Physicians
Agency for Healthcare Research and Quality
American Dietetic Association
American Occupational Therapy Association
American Physical Therapy Association
CDC National Lung Education Program
Centers for Medicare and Medicaid
Institute for Healthcare Improvement
Institute of Medicine
National Chronic Care Consortium
National Guideline Clearinghouse
National Heart, Lung and Blood Institute
GOLD Strategy
Registered Nurse Association of Ontario
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission

Urinary
Agency for Healthcare Research and Quality
American Urological Association
CDC
Centers for Medicare and Medicaid
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
NICE (National Institute for Health and Clinical Excellence (NICE)
Robert Wood Johnson Foundation
The Joint Commission

Wounds
Agency for Healthcare Research and Quality
American Professional Wound Care Association
Association for the Advancement of Wound Care
Canadian Association of Wound Care
CDC
Centers for Medicare and Medicaid
European Wound Management Association
HSE National Guidelines for Wound Management
Institute for Healthcare Improvement
National Chronic Care Consortium
National Guideline Clearinghouse
National Pressure Ulcer Advisory Panel (European Pressure Ulcer Panel)
NICE (National Institute for Health and Clinical Excellence (NICE)
WOCN
Robert Wood Johnson Foundation
The Joint Commission

Telehealth
Accreditation Canada
Agency for Healthcare Research and Quality
American Telemedicine Association
Center for Telemedicine and Telehealth

Transitional Care
Agency for Healthcare Research and Quality
American Academy of Family Physicians
Dr. Coleman’s Transitional Care Model
HHQI National Campaign
National Transitions of Care Coalition
Society of Hospital Medicine Project Boost
University of Pennsylvania Transitional Care Model: Mary Naylor

General Information/Sources
AHRQ
ECRI Institute
HCAF
Home Health Line
IHI
NIH Senior Health
The Joanna Briggs Institute
The Remington Report
TMF Health Quality Institute

Ways of Stopping Inappropriate and Unnecessary Prescription of Antibiotic for Respiratory Infection

Bethzaida V. Linga

Dr. Krista Krause

October 21, 2014

Inappropriate and Unnecessary Prescription of Antibiotic for Respiratory Infections
Introduction
Research has indicated that more than half of respiratory infections are as a result of viruses. The various respiratory infections that clinicians prescribe antibiotics for include but not limited to sore throat, sinusitis, ear infection, bronchitis and upper respiratory infection. Some of these respiratory infections do not need the prescription of antibiotics and therefore medical experts argue that their prescription is more than what is needed. In the United States alone, over 11 million antibiotic prescription to children and minors are unnecessary and sometimes harmful (Beracochea et al., 2011). Antibiotics are only useful in cases where the infections are caused by bacteria. Unfortunately, a majority of the respiratory infections are viral and therefore antibiotics are prescribed unnecessarily and inappropriately.
The American Academy of Pediatrics published a study conducted by Dr. Matthew Kronman, which highlighted how antibiotics are inappropriately and unnecessarily prescribed to young children and teens. The research found out that there are 57% antibiotic prescriptions for all respiratory infections reported (Beracochea et al., 2011). However, the research also found out that out of the 57% prescriptions, there are only 27% infections that are caused by bacteria. In this regard, it is evident that there are more than half antibiotics prescriptions that are unnecessary.
Clinical Excellence
Nurses have the responsibility of ensuring that they deliver the best quality care to their patients. Clinical excellence, according to the National Health Service, is ensuring that clinical officers and nurses offer the best possible quality care to patients. Health professionals must be in the frontline in educating the members of the public on the dangers of unnecessary prescription of antibiotics. More often than not, health care providers do not have equipment that can determine whether a respiratory infection is a viral or a bacterial disease. Therefore, it is inevitable that the nurse practitioners end up prescribing antibiotics even in cases where they are not needed.
Inappropriate and unnecessary prescription of antibiotics for respiratory infections has long term side effects and is also costly. The development of antibiotic resistant infections has largely been blamed on these unnecessary prescriptions. There are instances where health professionals argue that they do not have sufficient time to do all what is required to offer quality care to a patient. As a result, cases of inappropriate prescriptions occur and the side effects are dire. According to the National Healthcare Safety Network, healthcare providers, administrators, patients and the government policy makers have a role to play in ensuring clinical excellence (Beracochea et al., 2011).
The healthcare providers must provide the necessary and correct care through carrying out the relevant tests. They must ensure that patients are given the right drugs and the right dosage. The healthcare providers must also reassess the antibiotic prescriptions after 48 hours on the basis of the tests they carried out and the patient examination. In order to attain clinical excellence, it is prudent for the healthcare providers to keep record of the antibiotic’s dosage and duration in their healthcare facility. All the nurse practitioners must work on the realm of respect for patients, generosity and doing justice (Slawson et al., 2012). These are ethical standards that are essential in providing holistic patient-centered healthcare. Justice in the healthcare profession is an obligation upon the healthcare providers to offer quality care according to the law. Respect for patients encompasses doing what is good to the patients and avoiding harming the patient. Generosity on the hand requires the healthcare provider to offer quality and patient centered care according to the established morals. All the above three ethical principles must be put in place in order to provide quality patient centered healthcare services. Clinical excellence is also achieved through collaboration, consultation and continuous education. It is also imperative for the healthcare providers to have self-reflection sessions.
The healthcare center administrators have the responsibility of developing a working feedback system from the patients. This should be aimed at ensuring that the nurses and or the health professionals are able to attain excellence over time. Unnecessary and inappropriate prescription of antibiotics or over prescription of antibiotics has numerous side effects. Beside the development of antibiotic resistant bacterial infections, the ailing patient may suffer and can also infect other people (Slawson et al., 2012). It is evident that with proper prescription of antibiotics for respiratory infections, the side effects of unnecessary and inappropriate prescriptions will be avoided.
A Model for Change
Various national health institutions provide information regularly on how to improve healthcare provision to the people. For the case of unnecessary and inappropriate prescription of antibiotics for respiratory infections, there are various models for change that can be adopted to alleviate the problem. Research has indicated that the problem is fueled by the lack of awareness and health information to both the clinical nurses and the patients (Chambers et al., 2013). Majority of patients with viral respiratory infections insist on being given a dosage of antibiotics. In the entire of Europe, antibiotic awareness campaigns are carried out every year. This is aimed at educating the public and the entire healthcare industry on the dangers of wrongful prescription of antibiotics.
The awareness campaign, which is supported by Department of Health and its Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections has achieved tremendous success in reducing cases of inappropriate antibiotics prescription. The CDC’s National Healthcare Safety Network has come up with various strategies that can be used to deal with this problem.
Antibiotic Stewardship Programs
These are programs that can be adopted in the healthcare facilities or outpatient settings like clinics to deal with the issue of wrongful prescription of antibiotics for respiratory infections. In order to achieve the outcomes of the program, it is prudent to appoint a leader for accountability purposes. Research has indicated that physicians can offer the best leadership for antibiotic stewardship programs. It is imperative to ensure that the program has enough resources, human resource personnel and the necessary information technology equipment (Chambers et al., 2013). Prescription improvement actions such reassessment after 48 hours must be incorporated into the program to ensure its success.
Tracking of the various trends of prescribing and antibiotic resistance cases is essential in order to take the necessary action. The patters obtained from the tracking must be communicated to the staff in order to come up with ways of improving. The program also encompasses education to the staff on improving the prescription practices, as well as about antibiotic resistance (Slawson et al., 2012). It is also vital to work with other healthcare facilities to avoid further infections and or transmissions.
Theoretical Model and Framework
Community Health Promotion Model
Promoting healthy practices amongst the community is one of the best models to address the problem of unnecessary prescription of antibiotics for respiratory infections. There are numerous cases where the patients are the ones who insist that the nurse practitioner should prescribe a particular antibiotic for their illness (Slawson et al., 2012). However, the patient might be unaware that the ailment does not need an antibiotic. Additionally, it is evident that a majority of patients purchase antibiotics, or store antibiotics that prescribed to them for future use. Equally, there are patients who use antibiotics that were prescribed for other people whom they assume have similar illness as theirs.
It is, therefore, extremely necessary to educate the populace on the proper ways of using antibiotics. This will help in reducing the numerous cases of antibiotic resistant bacteria. It is vital to educate the public on taking the preventive measures by following the prescription and dosage directives from the health professionals.
Step 1: Assess the Need for Change in Practice
Problem
The main aim of this model is to offer preventive measures as opposed to curative measures. The public must be educated on the dangers of unnecessary prescription on a timely manner to avoid the discussed side effects. However, there is always the problem of reaching the entire population. There are people who are unreachable and therefore the problem of antibiotic resistant bacteria continues. The cost of educating the public about antibiotic resistance and over prescription, as well as inappropriate prescription is a major hindrance.
Intervention
The use of health practitioners at health facilities will enable transmission of knowledge to the patients suffering from respiratory infections or antibiotic resistant bacterial infections. It is critical for the nurses at the health facilities to offer education to the patients with regard to antibiotic prescriptions (Beracochea et al., 2011). Provision of the right antibiotics is also essential to ensure that the patients are offered quality patient centered healthcare. The health practitioners must also offer advice to the patient on the various healthy lifestyles and the measures to take to avoid over prescription, unnecessary prescription or antibiotic resistance.
Goals
The healthcare providers must set goals for patients practicing over prescription of antibiotics or patients who are taking antibiotics unnecessarily. The providers can set out activities that involve proper prescription of antibiotics to a patient by a health practitioner.

Step 2 Locating the Best Evidence
Literature Review
Antibiotics are powerful medicines used to treat humans and animals. The importance of antibiotics cannot be under estimated because with proper administration of antibiotics most bacterial infections and disease can be effectively treated. Antibiotics kill bacteria or keep them from reproducing. However, antibacterial cannot kill viruses or treat infections caused by viruses. These are diseases such as colds, bronchitis, flu and sore throats unless caused by strep. Improper use of antibiotics is very dangerous to a person’s health, improper administration of antibiotics leads to bacterial resistance to common antibiotics. Therefore, a person should always ensure that the finish their medicine even when they feel better.  It is also necessary to take the medicines as prescribed by the pharmacist. Failure to take antibiotics can make a person get infections that antibiotics cannot cure. Methicillin-resistance Staphylococcus aureus (MRSA) causes infections that are resistant to several common antibiotics. This information is great but not really part of this section of this paper.
Methods
Search Strategy on the evidence on effect of inappropriate administration of antibiotics for respiratory diseases.
According to a study recorded in the Journal of American Medical Association it was found that doctors are prescribing antibiotics to children more frequently than is necessary. Researchers at Brigham and Women’s Hospital and Harvard Medical School compared the rate of antibiotic prescriptions for sore throats to the rate of testing for group A B-hemolytic streptococci (GABHS) or strep throat. These bacteria are responsible for 15% to 36% of sore throats in children. The researchers used data collected from 1995 to 2003 as part of the US National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. It was found out that antibiotics were prescribed in 48% of visits where doctors tested for strep and 51% of visits where no test was done. A statistical analysis found no relationship between testing and the likelihood of receiving a prescription for antibiotics (Dr. Jeffrey A. Linder et al,).
This section is labeled the methods but this does not talk about the methods that you used to search for the literature. Also this is not cited appropriately at all. What did you search, where, and what did you find?
Step 3    Critically Analyze the Evidence
According to the evidence presented in the Journal of American Medical Association there is an urgent need for intervention and awareness campaign on proper administration of antibiotics by doctors. On the other hand patients should also be aware of the dangers they put themselves when they take antibiotics in appropriately. The good news from the research done by the Journal of American Medical Association, statistical data from the report suggests that there is a decrease in the improper administration of antibiotics (Dr. Jeffrey A. Linder et al,). There is also an encouraging report due to advancement technologies there are now antibiotics that are easier to administer to the patient due to their more convenient dosing schedule. In other modern antibiotics, the period required to complete a full dose is short, therefore, there is full uptake of the medicine by patients (Levy RA.)
There is also an excessive administration of antibiotics to patients. According to the Centers for Disease Control and Prevention (CDC), antibiotic prescribing in outpatient settings could be reduced by more than 30 percent without adversely affecting patient health. Some of the reasons cited for this negligence are too much pressure on the doctor and demand for quick recovery by patients.

Step 3   Feasibility, Benefits, and Risk
Feasibility evaluates and analyses the potential of the proposed project based on the extensive research to support decision makingdecision-making. The model proposed above is logical and feasible since it takes into account all the affected healthcare groups in the society. The inclusive nature of the model gives it an edge since it is acceptable and sits well with the general patient population. The healthcare organization especially outpatient settings would adopt this model since all parties stand to benefit.
Measures taken to stop inappropriate prescription of antibiotics for respiratory diseases

The FDA and CDC have launched a nationwide antibacterial campaign so as to reduce the demand and oversubscription of antibiotics. They have developed a nationwide ad campaign to emphasize to the health care professionals on the prudent use of antibiotics. The FDA and CDC also offer educational brochures teaching them on the proper use of antibiotics. In 2003 the FDA published a rule that requires specific language on human antibiotics with labels to encourage doctors to use them when only necessary and to counsel their patients on proper use of these drugs.
Scientists and health professionals are generally in agreement that a way to decrease antibiotic resistance is through more cautious use of antibiotic drugs and through monitoring outbreaks of drug resistant infections. Research on the various mechanisms through which bacteria evade drugs is being steadily undertaken. The FDA’s National Center for Toxicological Research (NCTR) is studying the mechanisms of resistance to antibiotic agents in bacteria.

A case study on the impact of improper administration of antibiotics published in the Journal of American Medical Association was able to show benefits of proper administration of antibiotics. In this study, key factors on that are entailed in administration of antibiotics were identified. A multifaceted approach was used. Household and office-based patient education materials and a clinician educational assistance were made available. The following information was sent to 25,000 households:
•    Information about self-care and prevention against diseases. When to seek care and what to expect from hospital visits for colds, flu and bronchitis diseases.
•    A pamphlet produced by CDC on proper use of antibiotics.
•    A pamphlet addressing proper hand washing techniques.
•    A letter announcing a campaign to combat antibiotic resistance by reducing unnecessary antibiotic use.
At the doctor’s office there were posters attached to the wall of each room, with information on the limited role of antibiotics in acute bronchitis or chest colds for patients.
There was also a complete doctor and nurse education training program. All adults ailing bronchitis, sinusitis or upper respiratory tract infection who came to the clinic for medication were put under study.
It was found that proper use of antibiotics led to a decline in the number of patients returning for repeat treatment of same disease (R Gonzales et al,)

Benefits
The most important benefit of the ways of stopping inappropriate and unnecessary prescription of antibiotic for respiratory infections would be the realization of a healthy and antibiotic free society. It would be as an outcome of the combined effort between the government, the health care institutions and the society. These can be easily implemented since each healthcare providers, and patients plays their part. It would also largely reduce the antibiotic resistance infection and cost of treatment.

Risk
The downside of the proposed model would be the cultural acceptance among the people. Not all patients would be willing to accept the new norm, and would risk failure. It also propagates a particular kind of bureaucracy whereby hospitals would charge so highly for treatment and sophisticated testing.
Just like with all medicines, antibiotics have a number of side effects, and risk when prescribed inappropriately and unnecessary. Most side effects of antibiotics are not life threatening. The common side-effects of antibiotics include: diarrhea and mild stomach upset such as nausea. Antibiotics can kill beneficial bacteria which live in the vagina and bowels. This bacteria helps in digestion and fight off infectious bacteria. Some antibiotics may also react with contraceptives making them ineffective. These are antibiotics that contain rifampicin. (Dr. Tim Kenny)

Conclusion
The fight against improper prescription of antibiotics for respiratory diseases is a challenging and complex war. This is because bothbecause the doctors, as well as other health care providers, and the patients need to be educated on the proper use of antibiotics. The decrease in the rate of improper prescription of antibiotics shows that there is hope for proper use of antibiotics in future (Dr. Jeffrey A. Linder et al,). However, we are still far from the desired position and more efforts need to be done.

References
AHRQ’s Efforts to Prevent and Reduce Health Care Associated Infections. (n.d.). Retrieved October 23, 2014, from http://www.ahrq.gov/research/findings/factsheets/haiflyer/index.html
Beracochea, E., Weinstein, C., & Evans, D. P. (2011). Rights-based approaches to public health.     New York: Springer Pub. Co.
Blaser, M. (n.d.).”Missing microbes, how overuse of antibiotics is accelerating modern   plagues” (1st Ed.).
Cunha BA. (1998), The importance of compliance with oral antibiotic regimens. Advances in Therapy.
Chambers, R., Wakley, G., & Blenkinsopp, A. (2013). Supporting self-care in primary care.     Abingdon: Radcliffe
High rates of unnecessary prescribing of antibiotics. (2013, October 3). Retrieved October 23, 2014, from http://www.sciencedaily.com/releases/2013/10/131003121256.htm
Lieberman, P. (n.d.). “A strategic plan to preserve the impact of antibiotics.” Retrieved   October 23, 2014, from https://www.cspinet.org/reports/abiotic.htm
Lim, F. (n.d.).”What nurses need to know about the resistance of antibiotics”. Retrieved   October 23, 2014, from http://www.minoritynurse.com/article/what-nurses-need-know-about-antibiotic-resistance

Slawson, D., Shaughnessy, A., & Ebell, M. (2012). Essential Evidence: Medicine That Matters.     Hoboken: John Wiley & Sons.
R Gonzales et al. (1999). Decreasing antibiotic use in ambulatory practice. Impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults: Journal of American Medical Association
Southwick, F. (2008). Infectious diseases: A clinical course (2nd Ed.). New York: McGraw-Hill Medical.
Wilson, L. (2012, April 1). Beyond Antibiotics. Retrieved October 23, 2014, from http://www.drlwilson.com/articles/antibiotics.htm

Bethzaida,
There were many of aspects of the second part of the paper that are missing or not adequately covered. You only cited two or three resources but do not adequately describe the best evidence or provide a synthesis. Make sure to use the book as your guide for the synthesis. You needed to address the consistencies, inconsistencies, etc.. There were also many APA errors with no appropriate citations throughout.
A. Content
60% of grade    0 points    1 point    2 points    3 points    Total Points
Step 2: Locate the Best Evidence
(Literature Review)    No project submitted

Gives a brief overview of describes the best evidence via a review of few resources    Describes the best evidence via a review of some relevant resources    Thoroughly describes the best evidence via a thorough review of relevant resources
Step 3: Critically Analyze the Best Evidence (Synthesis)    No project submitted     Provides an overview of  best evidence without a clear synthesis or link to problem/solution    Provides a synthesis of best evidence that points indirectly to the need for more with problem/solution    Provides a synthesis of best evidence clearly points to the need for more with problem/solution

A.  Content Rubric Points    __4_/6
A.    Content %    ___%
B.  Organization and Formatting
40% of grade    0 points    1 point    2 points    3 points    Total Points
Organization
Paper or project was organized
No project submitted    Project lacks organization.  Paragraphs lack focus and sentences stray from topic to topic     Project lacks focused introduction and/or conclusion.  Some sentences do not support main topic of each paragraph.    Project includes introduction, body and conclusion.  Sentences support main topic of each paragraph.
Ideas were stated clearly and logically
No project submitted    Ideas were not stated clearly.  Project may include excessive jargon and/or many unsupported arguments.     Some ideas were stated clearly.  Project may include some unnecessary jargon and/or several unsupported arguments.    All ideas were stated clearly.  Writer avoids unnecessary jargon and develops logical arguments.
Content relevance    No project submitted    Project was off topic and not relevant.    Some portions of project were on topic and relevant.    Project was thoroughly on topic and relevant.
Formatting
Adherence to formatting guidelines
No project submitted    No formatting guidelines were followed    Some guidelines were followed    All formatting guidelines were followed
Spelling and grammatical errors
No project submitted    More than 6 spelling or grammatical errors    Less than 6 spelling or grammatical errors    No spelling or grammatical errors

B.  Organization/
Formatting Rubric Points    _10__/15
A.    Org. & Formatting %    ____%
Grade Book Pts. = [(A% x .6) + (B% x .4)] x # of points for assignment    FINAL GRADE:

_133.2__ /# of assignment points

Ways of Stopping Inappropriate and Unnecessary Prescription of Antibiotic for Respiratory Infection

Bethzaida V. Linga

Dr. Krista Krause

October 21, 2014

Inappropriate and Unnecessary Prescription of Antibiotic for Respiratory Infections
Introduction
Research has indicated that more than half of respiratory infections are as a result of viruses. The various respiratory infections that clinicians prescribe antibiotics for include but not limited to sore throat, sinusitis, ear infection, bronchitis and upper respiratory infection. Some of these respiratory infections do not need the prescription of antibiotics and therefore medical experts argue that their prescription is more than what is needed. In the United States alone, over 11 million antibiotic prescription to children and minors are unnecessary and sometimes harmful (Beracochea et al., 2011). Antibiotics are only useful in cases where the infections are caused by bacteria. Unfortunately, a majority of the respiratory infections are viral and therefore antibiotics are prescribed unnecessarily and inappropriately.
The American Academy of Pediatrics published a study conducted by Dr. Matthew Kronman, which highlighted how antibiotics are inappropriately and unnecessarily prescribed to young children and teens. The research found out that there are 57% antibiotic prescriptions for all respiratory infections reported (Beracochea et al., 2011). However, the research also found out that out of the 57% prescriptions, there are only 27% infections that are caused by bacteria. In this regard, it is evident that there are more than half antibiotics prescriptions that are unnecessary.
Clinical Excellence
Nurses have the responsibility of ensuring that they deliver the best quality care to their patients. Clinical excellence, according to the National Health Service, is ensuring that clinical officers and nurses offer the best possible quality care to patients. Health professionals must be in the frontline in educating the members of the public on the dangers of unnecessary prescription of antibiotics. More often than not, health care providers do not have equipment that can determine whether a respiratory infection is a viral or a bacterial disease. Therefore, it is inevitable that the nurse practitioners end up prescribing antibiotics even in cases where they are not needed.
Inappropriate and unnecessary prescription of antibiotics for respiratory infections has long term side effects and is also costly. The development of antibiotic resistant infections has largely been blamed on these unnecessary prescriptions. There are instances where health professionals argue that they do not have sufficient time to do all what is required to offer quality care to a patient. As a result, cases of inappropriate prescriptions occur and the side effects are dire. According to the National Healthcare Safety Network, healthcare providers, administrators, patients and the government policy makers have a role to play in ensuring clinical excellence (Beracochea et al., 2011).
The healthcare providers must provide the necessary and correct care through carrying out the relevant tests. They must ensure that patients are given the right drugs and the right dosage. The healthcare providers must also reassess the antibiotic prescriptions after 48 hours on the basis of the tests they carried out and the patient examination. In order to attain clinical excellence, it is prudent for the healthcare providers to keep record of the antibiotic’s dosage and duration in their healthcare facility. All the nurse practitioners must work on the realm of respect for patients, generosity and doing justice(Slawson et al., 2012). These are ethical standards that are essential in providing holistic patient-centered healthcare. Justice in the healthcare profession is an obligation upon the healthcare providers to offer quality care according to the law. Respect for patients encompasses doing what is good to the patients and avoiding harming the patient. Generosity on the hand requires the healthcare provider to offer quality and patient centered care according to the established morals. All the above three ethical principles must be put in place in order to provide quality patient centered healthcare services. Clinical excellence is also achieved through collaboration, consultation and continuous education. It is also imperative for the healthcare providers to have self-reflection sessions.
The healthcare center administrators have the responsibility of developing a working feedback system from the patients. This should be aimed at ensuring that the nurses and or the health professionals are able to attain excellence over time. Unnecessary and inappropriate prescription of antibiotics or over prescription of antibiotics has numerous side effects. Beside the development of antibiotic resistant bacterial infections, the ailing patient may suffer and can also infect other people (Slawson et al., 2012). It is evident that with proper prescription of antibiotics for respiratory infections, the side effects of unnecessary and inappropriate prescriptions will be avoided.
A Model for Change
Various national health institutions provide information regularly on how to improve healthcare provision to the people. For the case of unnecessary and inappropriate prescription of antibiotics for respiratory infections, there are various models for change that can be adopted to alleviate the problem. Research has indicated that the problem is fueled by the lack of awareness and health information to both the clinical nurses and the patients (Chambers et al., 2013). Majority of patients with viral respiratory infections insist on being given a dosage of antibiotics. In the entire of Europe, antibiotic awareness campaigns are carried out every year. This is aimed at educating the public and the entire healthcare industry on the dangers of wrongful prescription of antibiotics.
The awareness campaign, which is supported by Department of Health and its Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections, has achieved tremendous success in reducing cases of inappropriate antibiotics prescription. The CDC’s National Healthcare Safety Network has come up with various strategies that can be used to deal with this problem.
Antibiotic Stewardship Programs
These are programs that can be adopted in the healthcare facilities or outpatient settings like clinics to deal with the issue of wrongful prescription of antibiotics for respiratory infections. In order to achieve the outcomes of the program, it is prudent to appoint a leader for accountability purposes. Research has indicated that physicians can offer the best leadership for antibiotic stewardship programs. It is imperative to ensure that the program has enough resources, human resource personnel and the necessary information technology equipment (Chambers et al., 2013). Prescription improvement actions such reassessment after 48 hours must be incorporated into the program to ensure its success.
Tracking of the various trends of prescribing and antibiotic resistance cases is essential in order to take the necessary action. The patters obtained from the tracking must be communicated to the staff in order to come up with ways of improving. The program also encompasses education to the staff on improving the prescription practices, as well as about antibiotic resistance(Slawson et al., 2012). It is also vital to work with other healthcare facilities to avoid further infections and or transmissions.
Theoretical Model and Framework
Community Health Promotion Model
Promoting healthy practices amongst the community is one of the best models to address the problem of unnecessary prescription of antibiotics for respiratory infections. There are numerous cases where the patients are the ones who insist that the nurse practitioner should prescribe a particular antibiotic for their illness (Slawson et al., 2012). However, the patient might be unaware that the ailment does not need an antibiotic. Additionally, it is evident that a majority of patients purchase antibiotics, or store antibiotics that prescribed to them for future use. Equally, there are patients who use antibiotics that were prescribed for other people whom they assume have similar illness as theirs.
It is, therefore, extremely necessary to educate the populace on the proper ways of using antibiotics. This will help in reducing the numerous cases of antibiotic resistant bacteria. It is vital to educate the public on taking the preventive measures by following the prescription and dosage directives from the health professionals.
Step 1: Assess the Need for Change in Practice
Problem
The main aim of this model is to offer preventive measures as opposed to curative measures. The public must be educated on the dangers of unnecessary prescription on a timely manner to avoid the discussed side effects. However, there is always the problem of reaching the entire population. There are people who are unreachable and therefore the problem of antibiotic resistant bacteria continues. The cost of educating the public about antibiotic resistance and over prescription, as well as inappropriate prescription is a major hindrance.
Intervention
The use of health practitioners at health facilities will enable transmission of knowledge to the patients suffering from respiratory infections or antibiotic resistant bacterial infections. It is critical for the nurses at the health facilities to offer education to the patients with regard to antibiotic prescriptions(Beracochea et al., 2011). Provision of the right antibiotics is also essential to ensure that the patients are offered quality patient centered healthcare. The health practitioners must also offer advice to the patient on the various healthy lifestyles and the measures to take to avoid over prescription, unnecessary prescription or antibiotic resistance.
Goals
The healthcare providers must set goals for patients practicing over prescription of antibiotics or patients who are taking antibiotics unnecessarily. The providers can set out activities that involve proper prescription of antibiotics to a patient by a health practitioner.

Step 2 Locating the Best Evidence
Literature Review
Antibiotics are powerful medicines used to treat humans and animals. The importance of antibiotics cannot be under estimated because with proper administration of antibiotics most bacterial infections and disease can be effectively treated. Antibiotics kill bacteria or keep them from reproducing. However, antibacterial cannot kill viruses or treat infections caused by viruses. These are diseases such as colds, bronchitis, flu and sore throats unless caused by strep. Improper use of antibiotics is very dangerous to a person’s health, improper administration of antibiotics leads to bacterial resistance to common antibiotics. Therefore, a person should always ensure that the finish their medicine even when they feel better.  It is also necessary to take the medicines as prescribed by the pharmacist. Failure to take antibiotics can make a person get infections that antibiotics cannot cure. Methicillin-resistance Staphylococcus aureus (MRSA) causes infections that are resistant to several common antibiotics.
Methods
Search Strategy on the evidence on effect of inappropriate administration of antibiotics for respiratory diseases.
According to a study recorded in the Journal of American Medical Association it was found that doctors are prescribing antibiotics to children more frequently than is necessary. Researchers at Brigham and Women’s Hospital and Harvard Medical School compared the rate of antibiotic prescriptions for sore throats to the rate of testing for group A B-hemolytic streptococci (GABHS) or strep throat. These bacteria are responsible for 15% to 36% of sore throats in children. The researchers used data collected from 1995 to 2003 as part of the US National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. It was found out that antibiotics were prescribed in 48% of visits where doctors tested for strep and 51% of visits where no test was done. A statistical analysis found no relationship between testing and the likelihood of receiving a prescription for antibiotics (Dr. Jeffrey A. Linder et al,).
This section is labeled the methods but this does not talk about the methods that you used to search for the literature. Also this is not cited appropriately at all. What did you search, where, and what did you find?
Step 3  Critically Analyze the Evidence
According to the evidence presented in the Journal of American Medical Association there is an urgent need for intervention and awareness campaign on proper administration of antibiotics by doctors. On the other hand patients should also be aware of the dangers they put themselves when they take antibiotics in appropriately. The good news from the research done by the Journal of American Medical Association, statistical data from the report suggests that there is a decrease in the improper administration of antibiotics (Dr. Jeffrey A. Linder et al,). There is also an encouraging report due to advancement technologies there are now antibiotics that are easier to administer to the patient due to their more convenient dosing schedule. In other modern antibiotics, the period required to complete a full dose is short, therefore, there is full uptake of the medicine by patients (Levy RA.)
There is also an excessive administration of antibiotics to patients. According to the Centers for Disease Control and Prevention (CDC), antibiotic prescribing in outpatient settings could be reduced by more than 30 percent without adversely affecting patient health. Some of the reasons cited for this negligence are too much pressure on the doctor and demand for quick recovery by patients.

Step 3Feasibility, Benefits, and Risk
Feasibility evaluates and analyses the potential of the proposed project based on the extensive research to support decision-making. The model proposed above is logical and feasible since it takes into account all the affected healthcare groups in the society. The inclusive nature of the model gives it an edge since it is acceptable and sits well with the general patient population. The healthcare organization especially outpatient settings would adopt this model since all parties stand to benefit.
Measures taken to stop inappropriate prescription of antibiotics for respiratory diseases

The FDA and CDC have launched a nationwide antibacterial campaign so as to reduce the demand and oversubscription of antibiotics. They have developed a nationwide ad campaign to emphasize to the health care professionals on the prudent use of antibiotics. The FDA and CDC also offer educational brochures teaching them on the proper use of antibiotics. In 2003 the FDA published a rule that requires specific language on human antibiotics with labels to encourage doctors to use them when only necessary and to counsel their patients on proper use of these drugs.
Scientists and health professionals are generally in agreement that a way to decrease antibiotic resistance is through more cautious use of antibiotic drugs and through monitoring outbreaks of drug resistant infections. Research on the various mechanisms through which bacteria evade drugs is being steadily undertaken. The FDA’s National Center for Toxicological Research (NCTR) is studying the mechanisms of resistance to antibiotic agents in bacteria.

A case study on the impact of improper administration of antibiotics published in the Journal of American Medical Association was able to show benefits of proper administration of antibiotics. In this study, key factors on that are entailed in administration of antibiotics were identified. A multifaceted approach was used. Household and office-based patient education materials and a clinician educational assistance were made available. The following information was sent to 25,000 households:
•    Information about self-care and prevention against diseases. When to seek care and what to expect from hospital visits for colds, flu and bronchitis diseases.
•    A pamphlet produced by CDC on proper use of antibiotics.
•    A pamphlet addressing proper hand washing techniques.
•    A letter announcing a campaign to combat antibiotic resistance by reducing unnecessary antibiotic use.
At the doctor’s office there were posters attached to the wall of each room, with information on the limited role of antibiotics in acute bronchitis or chest colds for patients.
There was also a complete doctor and nurse education training program. All adults ailing bronchitis, sinusitis or upper respiratory tract infection who came to the clinic for medication were put under study.
It was found that proper use of antibiotics led to a decline in the number of patients returning for repeat treatment of same disease (R Gonzales et al,)

Benefits
The most important benefit of the ways of stopping inappropriate and unnecessary prescription of antibiotic for respiratory infections would be the realization of a healthy and antibiotic free society. It would be as an outcome of the combined effort between the government, the health care institutions and the society. These can be easily implemented since each healthcare providers, and patients plays their part. It would also largely reduce the antibiotic resistance infection and cost of treatment.

Risk
The downside of the proposed model would be the cultural acceptance among the people. Not all patients would be willing to accept the new norm, and would risk failure. It also propagates a particular kind of bureaucracy whereby hospitals would charge so highly for treatment and sophisticated testing.
Just like with all medicines, antibiotics have a number of side effects, and risk when prescribed inappropriately and unnecessary. Most side effects of antibiotics are not life threatening. The common side-effects of antibiotics include: diarrhea and mild stomach upset such as nausea. Antibiotics can kill beneficial bacteria which live in the vagina and bowels. This bacteria helps in digestion and fight off infectious bacteria. Some antibiotics may also react with contraceptives making them ineffective. These are antibiotics that contain rifampicin. (Dr. Tim Kenny)

Conclusion
The fight against improper prescription of antibiotics for respiratory diseases is a challenging and complex war. This is because the doctors, as well as other health care providers, and the patients need to be educated on the proper use of antibiotics. The decrease in the rate of improper prescription of antibiotics shows that there is hope for proper use of antibiotics in future (Dr. Jeffrey A. Linder et al,). However, we are still far from the desired position and more efforts need to be done.

References
AHRQ’s Efforts to Prevent and Reduce Health Care Associated Infections. (n.d.). Retrieved October 23, 2014, from http://www.ahrq.gov/research/findings/factsheets/haiflyer/index.html
Beracochea, E., Weinstein, C., & Evans, D. P. (2011). Rights-based approaches to public health.     New York: Springer Pub. Co.
Blaser, M. (n.d.).”Missing microbes, how overuse of antibiotics is accelerating modern   plagues” (1st Ed.).
Cunha BA. (1998), The importance of compliance with oral antibiotic regimens. Advances in Therapy.
Chambers, R., Wakley, G., & Blenkinsopp, A. (2013). Supporting self-care in primary care.     Abingdon: Radcliffe
High rates of unnecessary prescribing of antibiotics. (2013, October 3). Retrieved October 23, 2014, from http://www.sciencedaily.com/releases/2013/10/131003121256.htm
Lieberman, P. (n.d.). “A strategic plan to preserve the impact of antibiotics.” Retrieved   October 23, 2014, from https://www.cspinet.org/reports/abiotic.htm
Lim, F. (n.d.).”What nurses need to know about the resistance of antibiotics”. Retrieved   October 23, 2014, from http://www.minoritynurse.com/article/what-nurses-need-know-about-antibiotic-resistance

Slawson, D., Shaughnessy, A., & Ebell, M. (2012). Essential Evidence: Medicine That Matters.     Hoboken: John Wiley & Sons.
R Gonzales et al. (1999). Decreasing antibiotic use in ambulatory practice. Impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults: Journal of American Medical Association
Southwick, F. (2008). Infectious diseases: A clinical course (2nd Ed.). New York: McGraw-Hill Medical.
Wilson, L. (2012, April 1). Beyond Antibiotics. Retrieved October 23, 2014, from http://www.drlwilson.com/articles/antibiotics.htm

Bethzaida,
There were many of aspects of the second part of the paper that are missing or not adequately covered. You only cited two or three resources but do not adequately describe the best evidence or provide a synthesis. Make sure to use the book as your guide for the synthesis. You needed to address the consistencies, inconsistencies, etc.. There were also many APA errors with no appropriate citations throughout.
A. Content
60% of grade    0 points    1 point    2 points    3 points    Total Points
Step 2: Locate the Best Evidence
(Literature Review)    No project submitted

Gives a brief overview of describes the best evidence via a review of few resources    Describes the best evidence via a review of some relevant resources    Thoroughly describes the best evidence via a thorough review of relevant resources
Step 3: Critically Analyze the Best Evidence (Synthesis)
Step 4: Design

Step 5: Implementation and evaluation

Step 6: Integration and maintenance

No project submitted

No project
Submitted

No project submitted

No project submitted      Provides an overview of  best evidence without a clear synthesis or link to problem/solution

Provides a brief description of the design without a clear connection to the issue

Briefly describes the implementation and evaluation process without pointing to the various factors such as finances and human resources

Briefly provides an overview of the integration process and maintenance measures for the program     Provides a synthesis of best evidence that points indirectly to the need for more with problem/solution

Clearly describes the design of the program but still needs more analysis

Describes the implementation process of the project and how evaluation will be done while considering the various factors such as finances and human resources

Clearly describes how the programs various stakeholders will be integrated together to provide a unified program. Clearly highlights the various measures for maintaining the program     Provides a synthesis of best evidence clearly points to the need for more with problem/solution

Clearly and thoroughly describes the design of the program and connects directly with the problem.

Clearly and succinctly describes how implementation of the program will take place. States the various phases of implementation and the results of evaluation. States the role evaluation plays in providing feedback for the programs performance.

Openly and clearly describe the various stakeholders in the program implementation and how they will be put together to work towards the achievement of the program’s goals. Describes how the resources will be divided amongst the various sections, as well as highlights how the human resources will be allocated to various regions. Gives a clear explanation of the maintenance process in terms of resources and human resource.

A.  Content Rubric Points    __4_/6
A.    Content %    ___%
B.  Organization and Formatting
40% of grade    0 points    1 point    2 points    3 points    Total Points
Organization
Paper or project was organized
No project submitted    Project lacks organization.  Paragraphs lack focus and sentences stray from topic to topic     Project lacks focused introduction and/or conclusion.  Some sentences do not support main topic of each paragraph.    Project includes introduction, body and conclusion.  Sentences support main topic of each paragraph.
Ideas were stated clearly and logically
No project submitted    Ideas were not stated clearly.  Project may include excessive jargon and/or many unsupported arguments.     Some ideas were stated clearly.  Project may include some unnecessary jargon and/or several unsupported arguments.    All ideas were stated clearly.  Writer avoids unnecessary jargon and develops logical arguments.
Content relevance    No project submitted    Project was off topic and not relevant.    Some portions of project were on topic and relevant.    Project was thoroughly on topic and relevant.
Formatting
Adherence to formatting guidelines
No project submitted    No formatting guidelines were followed    Some guidelines were followed    All formatting guidelines were followed
Spelling and grammatical errors
No project submitted    More than 6 spelling or grammatical errors    Less than 6 spelling or grammatical errors    No spelling or grammatical errors

B.  Organization/
Formatting Rubric Points    _10__/15
A.    Org. & Formatting %    ____%
Grade Book Pts. = [(A% x .6) + (B% x .4)] x # of points for assignment    FINAL GRADE:

_133.2__ /# of assignment points

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