Avoiding Liability Bulletin – March 1, 2016
Nurse practitioners provide care to patients with acute respiratory tract infections (ARTIs) in hospitals, clinics, and offices–either in their own office or in a physician’s office with whom the APRN collaborates. In any of these scenarios, you know all too well that automatically prescribing antibiotics may not be the best approach.
Properly prescribing antibiotics for respiratory tract infections can be somewhat easier when guidelines are available for doing so. The American College of Physicians and the Centers for Disease Control and Prevention (CDC) have just published Guidelines on the use of antibiotics for acute respiratory tract infections.1
The 2016 guiding principles underscore an approach of reducing the overuse of antibiotics. The Guidelines recommend using alternate forms of treatment for specific ARTIs when appropriate. For example, if you determine a patient is suffering from bronchitis, suggesting the use of cough suppressants and decongestants to treat patients’ symptoms is urged.
Likewise, a sore throat can be treated with analgesics such as aspirin and throat lozenges. Common cold symptoms, although aggravating, should be treated symptomatically as well.
Margaret Fitzgerald, NP, in her article, “Appropriate Antibiotic Prescribing”2, takes the same approach to prescribing antibiotics. They should be used only for patients with confirmed or presumed bacterial infections. Due to bacterial resistance to commonly prescribed antibiotics, she stresses “responsible prescribing”, which includes the “optimal drug at the proper dose, duration, frequency and route”.
Fitzgerald also requires a careful assessment of the patient’s symptoms and a proper diagnosis. In addition, she emphasizes the importance of educating patients about the fact that antibiotics are not effective with viral infections.
As a nurse practitioner, you need to conform to these guidelines and to additional indispensable practices in order to provide your patients with safe and effective care and reduce the potential for increasing bacterial resistance to antibiotics. Such a course of action also helps you practice in accordance with established standards of practice.
The American Association of Nurse Practitioners, in its Standards of Practice for Nurse Practitioners, also articulates your obligation of adhering to your standards of practice. Assessing the patient’s health status, prescribing or ordering appropriate pharmacologic and non-pharmacologic interventions, and continually providing competent care are a few examples of standards defined by the Association. You can read the entire Position Statement, and others, at www.aanp.org (click on the Publications tab).
Adhering to standards of practice is crucial. If you are named in a suit alleging professional negligence, standards of practice are introduced into evidence by nurse expert witnesses. Your conduct in the situation at issue in the trial will be compared to those standards of practice and your overall standard of care. If you are found not to be in conformity with them, a judgment against you is fairly certain.
1. Original content from John Anello, Brian Feinberg, John Heinegg, Richard Lindsey, Christine Wojdylo and Oo Wong. February Edition: New Guidelines and Recommendations. Medscape Drugs & Diseases. Available at: http://reference.medscape.com/features/slideshow/guidlines-review/2016/february#page=1 . Accessed 2/20/16. (Note: the entire article, as well as all other content on Medscape’s Drug and Disease website require a free, one-time registration).
2. Available at: Advance Healthcare Network for NPs & PAs, htpp://nurse-practitioners-and-physician-assistants.advanceweb.com/article/appropriate-antibiotic-prescribing.aspx. Accessed 2/20/16.
THIS BULLETIN IS FOR EDUCATIONAL PURPOSES ONLY AND IS NOT TO BE TAKEN AS SPECIFIC LEGAL OR ANY OTHER ADVICE BY THE READER. IF LEGAL OR OTHER ADVICE IS NEEDED, THE READER IS ENCOURAGED TO SEEK ADVICE FROM A COMPETENT PROFESSIONAL.