The Utilization of anti-infectives by nurse practitioners in Utah.

A retrospective record review was conducted to assess the appropriateness of anti-infective therapy initiated by nurse practitioners. Twenty-two nurse practitioners throughout Utah were studied; 220 records of patients treated with systemic anti-infectives were reviewed. The majorities of the nurse practitioners were educated in continuing education programs, practiced in urban settings, has less than two years of experience, and stated they prescribe anti-infectives on a daily basis. Patient records were examined for: sufficient evidence of bacterial infection, appropriate drug selection considering efficacy, toxicity and expense, and appropriate dosage. Appropriateness was judged according to criteria developed by a panel of experts through review of related literature. Judgments were categorized according to the appropriateness of therapy. Of 220 records reviewed, 47 percent were appropriate; 33 percent inappropriate; and 20 percent were not evaluable due to incomplete records where omission of the drug allergy history, dosage, or recent body weight in patients under 12 years old prevented evaluation of appropriateness. Of cases requiring diagnostic tests to substantiate bacterial infections, 40 percent were treated appropriately and 60 percent inappropriately. The most common error was prescribing without sufficient documented evidence of bacterial infection. Previous studies of physician in hospital practice reported approximately the same frequency of inappropriate anti-infective prescribing. Significant relationships between nurse practitioner and practice characteristics and appropriate and inappropriate prescribing frequencies were demonstrated. Further study is needed before generalization of other populations of nurse practitioners may be made; however, prescribing trends are suggested. Recommendations for improving education and legislative revision are discussed.