Highlights
- •An antibiotic stewardship bundle was implemented, consisting of displaying public commitment posters, installing evidence-based guidelines and clinical algorithms by computers, initiating a watchful waiting protocol with phone follow-up within 1 to 3 days, creating smart phrases and templates for common viral diagnoses, using delayed prescribing and symptom relief prescription pads, and conducting communication training
- •The percent of inappropriate antibiotic prescriptions had a statistically significant decrease from 54.7% to 35.4% (P = 0.0006).
- •Across all results pre- and post-intervention, bronchitis was the most frequent diagnosis to receive an inappropriate antibiotic prescription.
Abstract
Overprescribing antibiotics is currently a major issue in the outpatient setting.
Inappropriate antibiotic prescriptions are leading to costly adverse effects, including
antibiotic resistance. Antibiotic stewardship interventions are adaptable tools that
are readily available to prescribers to reduce the overuse of antibiotic prescriptions.
The purpose of this project was to implement an Antibiotic Stewardship Bundle in an
urgent care clinic. The overall aims of this project were to decrease the amount of
unnecessary antibiotics prescribed and increase best prescribing practice. The results
of the quality improvement project showed inappropriate antibiotic prescription rates
decreased from 54.7% to 35.4% (P = 0.0006).
Keywords
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References
- New CDC data show large percentage of antibiotics misused in outpatient settings.(Published May 3, 2016)https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.htmlDate accessed: November 1, 2021
- Overuse and overprescribing of antibiotics.https://www.cidrap.umn.edu/asp/overuse-overprescribing-of-antibioticsDate accessed: November 1, 2021
- Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States.JAMA Intern Med. 2018; 178: 1267-1269https://doi.org/10.1001/jamainternmed.2018.1632
- A quality improvement initiative to improve antibiotic stewardship at a federally qualified health center.J Nurse Pract. 2021; 17: 1033-1038https://doi.org/10.1016/j.nurpra.2021.04.002
- Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study.Health Technol Assess. 2019; 23https://doi.org/10.3310/hta23110
- Reducing antibiotic prescribing in primary care for respiratory illness.Pediatrics. 2020; 146e20200038https://doi.org/10.1542/peds.2020-0038
- Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial.Ann Fam Med. 2019; 17: 125-132https://doi.org/10.1370/afm.2356
- Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports.BMJ Open Qual. 2019; 8e000351https://doi.org/10.1136/bmjoq-2018-000351
- Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: Follow-up of a cluster-randomised controlled trial.PLoS Med. 2019; 16e1002733https://doi.org/10.1371/journal.pmed.1002733
- A multifaceted intervention improves prescribing for acute respiratory infection for adults and children in emergency department and urgent care settings.Acad Emerg Med. 2019; 26: 719-731https://doi.org/10.1111/acem.13690
- Core elements of outpatient antibiotic stewardship.MMWR Recomm Rep. 2016; 65: 1-12https://doi.org/10.15585/mmwr.rr6506a1
- Mitigate antimicrobial stewardship toolkit: a guide for practical implementation in adult and pediatric emergency department and urgent care settings.(Published April 13, 2018)https://www.saem.org/docs/default-source/saem-documents/mitigate-toolkit_final_4-13-18.pdfDate accessed: November 1, 2021
- Antibiotic stewardship for acute respiratory infections the Milstein toolkit for ambulatory care practices. United Hospital Fund.(Published November 2018)https://uhfnyc.org/media/filer_public/e3/73/e37348ef-c9d3-4fc8-bf71-7f4f216df4db/asptoolkit_20181107.pdfDate accessed: November 1, 2021
- Antibiotic prescribing and use: handouts & posters.(Updated October 7, 2021)https://www.cdc.gov/antibiotic-use/week/toolkit/handouts.htmlDate accessed: November 1, 2021
- Antibiotic prescribing and use: adult outpatient treatment recommendations.(Updated October 3, 2021)https://www.cdc.gov/antibiotic-use/clinicians/adult-treatment-rec.htmlDate accessed: November 1, 2021
- To prescribe or not to prescribe? Antibiotics and outpatient infections.(Updated October 21, 2019)https://stanford.cloud-cme.com/course/courseoverview?P=0&EID=20758Date accessed: November 1, 2021
Biography
Kelsey Bivacca, DNP, FNP-BC, is an alumna of the University of South Florida, Tampa, FL and can be contacted at [email protected]
Biography
Catherine Nadeau, DNP, FNP-BC,CNE, is an assistant professor at the University of South Florida, Tampa, FL.
Article info
Publication history
Published online: February 02, 2023
Footnotes
In compliance with standard ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
