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Antibiotic resistance

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Antimicrobial resistance occurs when micro-organisms (bacteria, viruses, fungi and parasites) render the antimicrobial medication useless. Resistance to antibiotics by bacteria (antibiotic resistance) is a major concern.

Remember:

  • the prevention of infection is essential to avoiding the need for antibiotics in all care settings
  • good hand hygiene helps to prevent infections
  • encourage vaccination to prevent infection
  • antibiotics do not work for viral infections (colds and flu)
  • always ensure that prescribers follow local antibiotic prescribing guidelines.

The importance of specimens

The quality of specimens obtained from patients affects patient management and the likelihood of successful treatment.

Remember:

  • before starting antibiotics, always try to take appropriate specimens and ensure pus is drained or foreign bodies removed as appropriate
  • ensure specimens are not taken from non-sterile sites such as urinary catheters or leg ulcers, without clinical evidence of infection
  • ensure specimens are stored appropriately and reach the laboratory as soon as possible to avoid specimen degradation and quicken processing.  

Key prescribing and administration practice points for the nursing team:

  • Seek urgent medical review for suspected sepsis or septic shock with first dose of antibiotics administered within 1 hour of diagnosis.
  • Check the following are included on patient’s prescription. If any of these are missing, contact the prescriber to amend the prescription.

  • Clinical indication for antibiotic.
  • Route.
  • Duration or review date.
  • Dose.
  • Allergy status including type of reaction. 
  • Frequency. 

  • Prioritise timely administration of antibiotics, particularly those by IV route. Ensure missed doses are given as soon as possible, as omitting a dose can lead to treatment failure.
  • Prompt a review of the patient and laboratory results before 72 hours and ensure an antibiotic plan is documented in the notes and a stop date on the prescription.
  • Highlight when patients are eligible for switch from IV to oral antibiotics as soon as possible.
  • Highlight if an antibiotic prescription has continued beyond the duration stated in local antibiotic guidelines without appropriate explanation on the patients’ prescription or in medical notes.

Reference: NHS England (2015) Patient safety alert addressing AMR through implementation of an antimicrobial stewardship programme.