HEALTHCARE PROVIDERS’ PERCEIVED BARRIERS TO EFFECTIVE ADMINISTRATION OF PRESCRIBED ANTIBIOTICS TO INPATIENTS IN NATIONAL ORTHOPAEDIC HOSPITAL ENUGU

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ABSTRACT

Antibiotics are chemical substances produced by microorganisms which have the capacity, in dilute solutions to inhibit the growth of or to kill other microorganisms. The advent of antibiotics has improved the prognoses of patients with bacterial infections. Unfortunately, the excessive and indiscriminate use of these antibiotics has led to the emergence of resistant organisms. Healthcare providers’ perceived barriers to effective administration of prescribed antibiotics to inpatients in National Orthopaedic Hospital Enugu have not been studied in Nigeria and in NOHE. This study investigated healthcare providers’ perceived barriers to effective administration of prescribed antibiotics to inpatients in National Orthopaedic Hospital Enugu. The study adopted a descriptive cross sectional design. From the target population of 344 doctors and nurses in NOHE, 273 met the inclusion criteria and were involved in the study. Data were collected using researcher-developed questionnaire. The instrument was validated by the researcher’s supervisor and two other experts in the department of nursing sciences that major in the field of measurement and evaluation. The reliability of the instrument was done using test re-test method within two weeks interval and computed using Pearson’s product moment which yielded a coefficient of 0.82. Data were analyzed with the aid of statistical package for social science (SPSS) version 20. The result showed financial constraint as the major patients’ barrier (3.4), improper timing as the major professional healthcare providers’ barrier (3.0) and lack of antibiotics stewardship as the major health system barrier (3.2) to antibiotics administration in NOHE. Hypotheses showed no significant relationship (p>0.05) between the professional status, gender and years of experience of the healthcare providers and their perceived barriers to effective antibiotics administration. Conclusion and recommendations: patients should be educated on antibiotics use, healthcare providers should administer antibiotics as prescribed and hospital system should monitor antibiotics administration to prevent resistance and for better healthcare outcome.

TABLE OF CONTENTS

Title page
Table of Content
List of Tables
List of figures
Abstract

CHAPTER ONE: INTRODUCTION
Background to the Study
Statement of the Problem
Purpose of the Study
Specific Objectives
Research Questions
Hypotheses
Significance of the Study
Scope of the study
Operational Definition of Terms

CHAPTER TWO: REVIEW OF RELATED LITERATURES
Conceptual Review
Concept of antibiotics
 Factors to be considered in selection of antibiotics
 Indications for antibiotics use in hospitals
Proper clinical use of antibiotics
Principles of antibiotics dosing
Strategic approaches to ensure judicious administration of antibiotics
Antibiotics policy
Antibiotics resistance
Theoretical review
Empirical studies
Summary of literature review

CHAPTER THREE: RESEARCH METHODS
Research design
Area of study
Population of study
Sample
Sampling procedure
Instrument for data collection
Validity of instrument
Reliability of instrument
Ethical consideration
Procedure for data collection
Method of data analysis

CHAPTER FOUR: ANALYSIS AND PRESENTATION OF RESULTS
Demographic characteristics of respondents
Objective 1
Objective 2
Objective 3
Hypothesis 1
Hypothesis 2
Hypothesis 3
Summary of Findings

CHAPTER FIVE:    DISCUSSION OF FINDINGS
Respondents’ characteristics
Patient related barriers
Healthcare providers’ related barriers
Health system related barriers
Summary
Conclusion
Implication for nursing practice
Limitations of the study
Recommendations
Suggestion for further studies
REFERENCES
APPENDICES

CHAPTER ONE
INTRODUCTION
Background to the Study    
Disease prevention, management and treatment require use of different classes of medications. One of the commonest classes of medications used for such purposes is antibiotics. Antibiotics are chemical substances produced by microorganisms which have the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics are also produced in the laboratory. Those that inhibit growth of microorganisms are said to be bacteriostatic and those that kill microorganisms are said to be bacteriocidal (Abu-Saeed, Joseph & Folake, 2013).
Since the discovery of antibiotics, many substances have become available for the treatment of infections. The advent of antibiotics, which are one of the most successful drug groups used in medicine, dramatically improved the prognoses of patients with bacterial infections. Their power in both therapy and prophylaxis was so convincing that many older antibiotics have never undergone controlled clinical trials. Unfortunately, following several decades of optimism, the excessive and indiscriminate use of these antibiotics in both human and veterinary practices has led to the emergence and dissemination of resistant organisms that endanger their efficacy, accompanied by unwanted side effects and high cost (Osama & Maha, 2012). Antibiotics use has been practiced with the aim of reducing/eradicating infections and it is estimated that prophylactic antibiotics would reduce the overall incidence of wound infection by 17 percent if administered appropriately (Ronald, Woods & Patchen, 2015).
The goal of antibiotics use is to reduce the incidence of postoperative wound infection or surgical site infections (SSIs), control of infection, prophylaxis and assumes use where contamination might occur, but has not yet happened.  Effective use of antibiotics in the hospital environment is therefore essential (Horan, Culver, Gaynes, Jarvis, Edwards & Reid, 2010). The role of antibiotics in preventing and treating infection has been recognized from the 1950s. Since that time, there has been an enormous amount of research, comment and opinion published that have advanced our understanding surrounding the use of antibiotics.
Globally, misuse of antibiotics, including failure to complete therapy, skipping of doses, reuse of leftover antibiotics, inappropriate choice of antibiotics, inappropriate combination, inappropriate dose regimen and too long duration of drug usage can potentially expose patients to suboptimal effectiveness of antibiotic therapy (Osama & Maha, 2012). Such antibiotic-taking behaviours can result in difficulty eradicating infectious bacteria and potentially create an environment that promotes antibiotic resistance (Osama & Maha, 2012). Antibiotic misuse or over-use may increase the emergence of resistant bacteria and as a result increase the selection pressure on physicians who tend to prescribe newer broad spectrum agents for excessive periods of time (Hulscher, & Grol van der Meer, 2010).
In Sub-Saharan Africa, irregular antibiotics administration has led to resistance which has become a large growing problem among patients and as a result, the effectiveness of currently available antibiotics is also decreasing and the problem of infection continues to rise due to the inability of the available antibiotics to eradicate the causative organisms of such infection. This has caused high cost of care, prolonged hospitalization, readmission and death among patients as well as the ever-increasing pressure on clinicians and providers to reduce the incidence and the burden of infections (Okonko, Soleye, Amusan, Ogun, Ogunnusi & Ejembi, 2009).
The administration of antibiotics (pre, intra and post operatively) is a common practice in Nigeria both in clean and contaminated/dirty surgical procedures due to fear of surgical site infections (SSIs), and in nonsurgical cases that require antibiotics (John & Obi, 2014). This has greatly achieved prevention of SSIs, eradication of pathogenic microorganisms and has encouraged speedy wound healing. Antibiotics is clearly recommended for certain orthopedic procedures such as; insertion of a prosthetic joint, ankle fusion, revision of a prosthetic joint, reduction of hip fractures, reduction of high-energy closed fractures and reduction of open fractures; non orthopaedic procedures such as gastrointestinal tract surgeries, plastic surgeries, eye surgeries etc and nonsurgical cases. Surgical procedures are associated with a risk of infection of 5 to 15 percent, reduced to less than three percent by regular and appropriate use of antibiotics (Culver, Horan, Gaynes, Martone, Jarvis & Emori, 2009).

Inappropriate antibiotics administration has led to resistance which is identified as a common problem in the world (Thuong, Shortgen, Zazempa, Girou, Soussy & Brun-Buisson, 2010). Resistance occurs when sub therapeutic dosage of the antibiotic is administered to cure or prevent infection thereby causing the microorganisms to develop adaptations in order to survive and resist future doses of antibiotics. Thus, subsequent administration of even therapeutic doses of the antibiotics will lead to non efficacy of the drugs towards inhibiting the growth or killing the microorganisms. Resistant isolates have been found in healthy persons and those with community acquired infection in developing countries (Abu-Saeed et al., 2013). Antibiotic resistance has become a serious problem in both developed and developing nations. In certain settings, such as hospitals and some child-care locations, the rate of antibiotic resistance is so high that the normal, low cost antibiotics are virtually useless. This leads to a never-ending ever-spiraling race to discover new and different antibiotics just to keep the healthcare providers from losing ground in the battle against infection (Kardas, Devine, Golembesky & Roberts, 2011)...... 

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