Using PEARLS to reduce unnecessary antibiotics

Nurse practitioners may unknowingly contribute to antimicrobial resistance in convenient care clinics.
Nurse practitioners may unknowingly contribute to antimicrobial resistance in convenient care clinics.

NEW ORLEANS -- The overprescribing of antibiotics, a major factor in the widespread development of antibiotic-resistant bacterial infections, can be reduced with patient and provider education, according to a speaker at the American Association of Nurse Practitioners 2015 meeting.

To decrease antibiotic prescribing for acute pharyngitis in adults in convenient care settings, Kim McGinn-Perryman, DNP, APRN, FNP-BC, of Cox Health in Seymor Missouri, and colleagues conducted a multi-tiered educational intervention.

After obtaining antibiotic prescribing rates, the investigators found NPs contribute to antibiotic resistance in these settings. “Highlighting antibiotic resistance on an individual level fostered ownership and responsibility,” said Perryman. “It only takes one person to weaken the chain.”

The educational intervention focused on three areas: implementing evidence-based guidelines for acute pharyngitis, learning communications strategies specific to illness and antibiotic prescribing, and improving knowledge of antibiotic resistance.

As part of the provider education, the researchers used the acronym PEARLS, which helps NPs empathize with patients while educating them on the proper treatment procedure. The PEARLS approach consists of the following:

  • Partnership: “I'm going to help you manage this.”
  • Empathy: “It sounds like you're really miserable.”
  • Apology: “I'm sorry you're feeling ill.”
  • Respect: “You did the right thing by coming in today.”
  • Legitimize. “I can understand why you think an antibiotic would work for this illness.”
  • Support: “Let me give you treatment suggestions.”

Perryman also emphasized the importance of providing a specific diagnosis by communicating the diagnosis in terms that patients find less threatening, as doing so may substantially reduce experience of receiving an antibiotic.

Using strategic communications specific to antibiotic use “can be easily learned and is a ready tool for providers in any care setting,” she said.

After the intervention was implemented in the convenient care centers, there was a 22% drop in antibiotic prescribing rates for pharyngitis from March 2013 through 2014. The intervention yielded several unanticipated effects -- antibiotic prescribing also went down 19% for tonsillitis and 14% for upper respiratory infection.

“Antibiotic prescribing results from a complex relationship between patients and NPs,” concluded Perryman. “Utilizing a multi-pronged intervention including both providers and patients can provide a model to reduce antibiotic prescribing, improve knowledge, and maintain satisfaction.”

References

  1. Perryman MK et al. “Promoting Evidence-Based Antibiotic Prescribing for Adult Pharyngitis.” Presented at: AANP 2015.  June 10-15; New Orleans.
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