Date of Award

Spring 5-15-2026

Degree Type

Dissertation

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Mary Ellen Roberts, DNP

Advisor

Margaret Huryk, D.N.P., A.P.N.-C.

Committee Member

Cristina Zikos, PharmD

Keywords

antibiotic stewardship, older adult patients, quality improvement, antimicrobial resistance, primary care, long-term care

Abstract

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and feedback, and peer comparison strategies aligned with current CDC stewardship frameworks (CDC, 2022). Findings support structured, behaviorally informed stewardship interventions to enhance patient safety and reduce antimicrobial resistance.

Keywords: antibiotic stewardship, older adult patients, quality improvement, antimicrobial resistance, primary care, long-term care

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