Nursing & Healthcare

Biography

Biography: Andrew Appello

Abstract

Inappropriate prescribing of antibiotics is a contributing factor to drug resistance.  As a result, overprescribing has become a medical dilemma in the United States.  In the case of acute adult rhinosinusitis, clinical guidelines state that the majority of infections are viral and do not respond to antibiotic therapy.  Watchful waiting with supportive care is the appropriate treatment in these cases.  However, acute rhinosinusitis is the fifth most common diagnosis for which antibiotics are prescribed in the US, 82% of patients with the diagnosis are prescribed antibiotics.  Research shows that clinicians do not uniformly adhere to treatment guidelines; therefore, clinicians must be trained in appropriate prescribing according to acute rhinosinusitis guidelines.  Antibiotic stewardship programs may be used to decrease antbiotic prescribing, increase patient satisfaction, and enhance provider satisfaction.  Tactics used in these programs include provider training on patient education, negotiation strategies, holding firm, delayed prescribing, and knowing when to giving in.  Barriers to implementation exist as these interventions require significant human resources including collaboration among clinical and non-clinical personnel and they require adequate capabilities from information technology.  However, the advanced practice nurse is a collaborative provider and, therefore, is in a unique position to facilitate the changes needed to implement such a program in the clinical setting.