Date of Award

Spring 3-5-2019

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Mary Ellen Roberts, DNP

Committee Member

Patricia Ricci-Allegra, PhD

Committee Member

Ana Hernandez, MD

Abstract

Antibiotic misuse and overuse are major contributors to antibiotic resistance which is responsible for the death of 23,000 American’s annually. There is a growing body of evidence that antibiotic stewardship programs are successful in reducing antibiotic prescribing rates while maintaining safe patient care. Research supports a multifaceted approach with an ongoing commitment to antibiotic stewardship. This quality improvement project aimed to reduce the overuse of antibiotics in pediatric acute respiratory tract infections (ARTIs), improve the percentage of children who received laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis, and to implement and measure the efficacy of watchful waiting for children diagnosed with acute otitis media (AOM) and upper respiratory tract infections (URI). At the start of the project, the quality improvement team implemented on-site educational sessions for 17 pediatric and family practice providers. After 3 months of data collection, there was a 1.8% increase in the percentage of children who were diagnosed with URI and were not dispensed an antibiotic prescription. There was a 10.5% increase in the percentage of children who received proper laboratory confirmation for the diagnosis and treatment of streptococcal pharyngitis. In addition, 70% of watchful waiting protocol patients with AOM improved without the use of antibiotics. Although these improvements were incremental, they demonstrate the success of a single quality improvement cycle and illustrate need for continued improvement efforts in an organization wide outpatient antibiotic stewardship program.

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