Antibiotic Stewardship in Select Upper Respiratory Infections: A Quality Improvement Project

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Butler, Kathleen
Frank, Jessalyn
Washburn University
School of Nursing
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Background/Problem: The misuse of antibiotics is a leading cause of antibiotic resistance. Antimicrobials (antibiotics) are prescribed by providers, regardless if they are warranted, in populations of all ages. Purpose: The purpose of this quality improvement project is to reduce the overuse of antibiotics by providers, thereby promoting antibiotic stewardship, with the implementation of multifaceted interventions for providers and patients (and their caregivers) of all ages, who presented with select acute upper respiratory symptoms at three Federally Qualified Health Centers (FQHCs) in eastern Kansas. Methods: This quality improvement (QI) project included a 21-question provider perception survey given to the five participating primary care providers that measured attitudes, subjective norms, perceived behavioral control, and behavioral intentions affecting antibiotic prescribing practices. The QI project also integrated a one-group pretest-posttest design through randomized chart audits before and after implementation of a provider educational in-service. Provider prescribing practices were compared to the National Institute for Health and Care Excellence Guidelines (NICE) guidelines for the treatment of select upper respiratory tract infections (URTIs). Results: Provider survey responses suggest that providers’ perceptions, intentions, and behaviors of inappropriate antibiotic use are influenced by complex interactions involving both patient-related and provider-related factors. Randomized chart review analysis revealed a decrease in the number of inappropriate antibiotics prescribed from 25% pre-intervention to 11% three months post-intervention. Conclusion: The QI project reduced inappropriate antibiotic prescribing for URTIs in the project population. To further expand this QI initiative, barriers for sustainability in implementation strategies should be addressed.