Date of Award

5-10-2019

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Theresa A. Kessler

Abstract

Antimicrobial resistance is a world-wide health crisis (Infectious Disease Society of America [IDSA], 2016; World Health Organization [WHO], 2017) expedited by the overuse/inappropriate use of antibiotics. In the outpatient setting it has been determined that approximately 60% of antibiotic therapies are prescribed (Centers for Disease Control and Prevention [CDC], 2016). Antibiotic stewardship is the coordinated effort to improve the use of antibiotic therapies, minimize misdiagnosis and delayed diagnosis and select appropriate antibiotic drug regimens (IDSA, 2016). The purpose of this evidence-based practice project was to evaluate the effects of an antibiotic stewardship program (presentation, survey collection, bimonthly e-mail reminders, patient education) for providers to determine prescribing practices for bronchitis. Pre-intervention, and post intervention chart audit for data collection was conducted based on the diagnosis code for bronchitis J20.9. Extensive literature review clearly supports bronchitis as the primary diagnosis which typically does not require antibiotic therapies (Schmidt et al., 2018). Outcomes measured included number of antibiotic prescriptions written for bronchitis before the antibiotic stewardship intervention and following the intervention. Also, the difference in prescribing rates for physicians and advanced practice registered nurses, also, provider attitudes towards antibiotic stewardship, and delayed prescribing. Chi-square test of independence was calculated comparing prescribing rates which remained consistent post intervention, (X2 (1) = 0.622, p >.05) indicating no statistical significance. An independentsamples t test was calculated comparing the mean scores of nurse practitioners and physicians. No significant statistical difference was found (t (2) = 0.283, p > .05). However, survey results yielded positive responses congruent with attendance at the intervention presentation. Influenced by the antibiotic stewardship program nurse practitioners prescribing of antibiotics decreased from 85% pre intervention to 82.5% post-intervention. Providers agreed the overuse of antibiotics has contributed to the problem of drug resistance and that antibiotic education for the public is important. The implementation of an antibiotic stewardship program presents an inexpensive intervention for the annual reintroduction of the detrimental effects of the mis/overuse use of antibiotics for providers and patients.

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